Social Networking and Teaching Social Networking and Teaching with Social Technologywith Social Technology

or, how does social networking impact health or, how does social networking impact health education?education?

Harry E. PenceHarry E. Pence

Distinguished Teaching ProfessorDistinguished Teaching Professor

Dept. of Chemistry and BiochemistryDept. of Chemistry and Biochemistry

SUNY OneontaSUNY Oneonta

http://www.wrapables.com/

The evolution of access to The evolution of access to patient information.patient information.

Where did a patient traditionally get Where did a patient traditionally get information?information?

Prominent medicaljournals

the friendly doctorinformativeadvertisements

This changed with the advent of This changed with the advent of the Internet.the Internet.

You might call this Web 1.0.You might call this Web 1.0.

online support groupsweb pages

Two major web sites ushered in the Two major web sites ushered in the e-Patient movement in the mid-1990’s.e-Patient movement in the mid-1990’s.

PubMed provides free access to the MEDLINE database PubMed provides free access to the MEDLINE database of more than 17,000,000 biomedical research articles.of more than 17,000,000 biomedical research articles.

WebMD is still the most popular U.S. health WebMD is still the most popular U.S. health portal. It provides health information, a symptom portal. It provides health information, a symptom checklist, personal information storage, pharmacy checklist, personal information storage, pharmacy information, and physician blogs. information, and physician blogs.

Patients used message Patients used message boards, distribution lists, boards, distribution lists, and blogs to share and blogs to share information about their information about their symptoms, diagnosis, symptoms, diagnosis, and treatment.and treatment.

The most popular sites are patient created.The most popular sites are patient created.

Patients with similar diseases not only offer Patients with similar diseases not only offer empathy and suggestions based on shared empathy and suggestions based on shared experience, often they can supplement experience, often they can supplement doctors’ opinions.doctors’ opinions.

www.manzanitavillage.org/coaching/fr_coaching.html

Doctors began to meet Doctors began to meet with patients who had with patients who had already done extensive already done extensive web research about web research about their diagnosis and/or their diagnosis and/or treatment.treatment.

http://www.uniongas.com/Businesshttp://www.uniongas.com/Business/otherci/energyefficiency/segments/otherci/energyefficiency/segments/institution.asp/institution.asp

““The old Industrial Age paradigm, in which health The old Industrial Age paradigm, in which health professionals were the exclusive source of professionals were the exclusive source of knowledge, is gradually giving way to a new knowledge, is gradually giving way to a new information age worldview.” Tom Ferguson, MDinformation age worldview.” Tom Ferguson, MD

Since 2006, increasing numbers of Since 2006, increasing numbers of online health sites have been created online health sites have been created that incorporated Web 2.0 that incorporated Web 2.0 technologies such as wikis, mash-technologies such as wikis, mash-ups, blogs, and video. ups, blogs, and video.

I would argue that the key component is I would argue that the key component is interactive, user-generated content , i.e. social interactive, user-generated content , i.e. social networking applied to health.networking applied to health.

Do physicians like the informed patient? Some Do physicians like the informed patient? Some do; some don’t. If the doctor objects to patient do; some don’t. If the doctor objects to patient research, patients either go elsewhere or hide research, patients either go elsewhere or hide their research!their research!

Where do patients get information in the Web 2.0 Where do patients get information in the Web 2.0 World?World?

A recent survey A recent survey (“How America (“How America Searches: Health Searches: Health and Wellness.” and Wellness.” Jan. 2008) asked Jan. 2008) asked this question.this question.

The Web (59%) was slightly more popular than The Web (59%) was slightly more popular than doctors (55%), and far ahead of pharmacists doctors (55%), and far ahead of pharmacists (18%) and nurses (15%).(18%) and nurses (15%).

Online is more popular with younger patients. Online is more popular with younger patients.

Logo from Health information Management Program - Univ. of Victoria.

Major Health 2.0 Web SitesMajor Health 2.0 Web Sites

AthenaHealth focuses on billing AthenaHealth focuses on billing and insurance regulations.and insurance regulations.

In addition to the old standards, like WebMD In addition to the old standards, like WebMD and PubMed, we now have new wikis, blogs, and PubMed, we now have new wikis, blogs, medical search engines, and portals.medical search engines, and portals.

Specialized Health Search Engines are multiplying.Specialized Health Search Engines are multiplying.Healia is a very powerful health search engine.Healia is a very powerful health search engine.

MEDgle searches symptoms, diagnoses, physicians, drugs, and MEDgle searches symptoms, diagnoses, physicians, drugs, and medical procedures.medical procedures.

iGuard.org focuses on the safety of perscription medicines.iGuard.org focuses on the safety of perscription medicines.

Enurgi aims to help elderly and disabled individuals.Enurgi aims to help elderly and disabled individuals.

Healthline and Aetna have combined to create a personalized search Healthline and Aetna have combined to create a personalized search engine.engine.

Some Major Health 2.0 PortalsSome Major Health 2.0 Portals

Each one hopes to Each one hopes to be the next health be the next health related MySpace!related MySpace!

According to Manhattan Research, some 9.9 According to Manhattan Research, some 9.9 million consumers regularly post health million consumers regularly post health information online and some sites focus on information online and some sites focus on capturing those experiences.capturing those experiences.

All three of the big search sites are now involved in health All three of the big search sites are now involved in health information.information.

What will it take for one of What will it take for one of these portals to become these portals to become the “Health MySpace?”the “Health MySpace?”

My guess is that e-patients will be more receptive My guess is that e-patients will be more receptive to sites that help them to not just access content, to sites that help them to not just access content, but also to connect and collaborate with others.but also to connect and collaborate with others.

It is increasingly hard for new sites to find a niche It is increasingly hard for new sites to find a niche to be filled.to be filled.

Since many people use a search engine to find a Since many people use a search engine to find a site, Google seems to have a built-in advantage.site, Google seems to have a built-in advantage.

Do Doctors use social Do Doctors use social networking?networking?

According to a Manhattan Research white paper:According to a Manhattan Research white paper:

almost 80,000 U.S. physicians currently almost 80,000 U.S. physicians currently participate in online physician communities.participate in online physician communities.

The online physicians tend to be older than The online physicians tend to be older than average; Westerners are more likely than those average; Westerners are more likely than those in the Northeast; and females are significantly in the Northeast; and females are significantly more likely than males.more likely than males.

There is a nice ranking (google, technorati, etc.) There is a nice ranking (google, technorati, etc.) of the top 100 health care blogs atof the top 100 health care blogs at

http://www.edrugsearch.com/top100/http://www.edrugsearch.com/top100/

Why have so many health sites been Why have so many health sites been created in such a short time?created in such a short time?

The Baby Boomer generation is reaching the The Baby Boomer generation is reaching the point where they are very concerned about point where they are very concerned about health and fitness.health and fitness.

Boomers recognize that they will have 20-30 Boomers recognize that they will have 20-30 years of life after they retire.years of life after they retire.

Broadband access and site creation tools are Broadband access and site creation tools are becoming much more widely used.becoming much more widely used.

Some vendors see a need to be served; others Some vendors see a need to be served; others see an abundant cash flow.see an abundant cash flow.

Accuracy and privacy are major Accuracy and privacy are major concerns.concerns.

Studies report that most of the online Studies report that most of the online health information is accurate, and most health information is accurate, and most errors are quickly corrected.errors are quickly corrected.

Patients who live with chronic diseases Patients who live with chronic diseases often know more about them than their often know more about them than their doctors. doctors.

Patients with serious diseases are more Patients with serious diseases are more concerned with getting information than with concerned with getting information than with maintaining their privacy. maintaining their privacy. (Ref:(Ref: The EconomistThe Economist, 4/11/2008, , 4/11/2008, http://www.economist.com/http://www.economist.com/

science/tq/displaystory.cfm?story_id=10676339science/tq/displaystory.cfm?story_id=10676339

Reputable sites conform to the Health on the Reputable sites conform to the Health on the Net Honor CodeNet Honor Code described atdescribed at ((http://www.hon.ch/HONcode/Conduct.html)http://www.hon.ch/HONcode/Conduct.html)

Obviously, an impressive set of Obviously, an impressive set of health information resources health information resources exists on the web (far more than exists on the web (far more than 200 sites).200 sites).

The orgy of new sites within the past few years resembles the dot.com bubble. The orgy of new sites within the past few years resembles the dot.com bubble. How will the best of these sites distinguish themselves from the masses? How will the best of these sites distinguish themselves from the masses?

Knowledge no longer consists of what is in my head or in my books, but rather is the collective Knowledge no longer consists of what is in my head or in my books, but rather is the collective wisdom of the group of individuals (“nodes”) that I am connected to and share with.wisdom of the group of individuals (“nodes”) that I am connected to and share with.

Where will potential users learn Where will potential users learn how to use these resources and how to use these resources and

which are best?which are best?

Let me highlight just a few possible changes.Let me highlight just a few possible changes.

The Millenial PatientThe Millenial Patient

Scott Shreeve, MD says that Scott Shreeve, MD says that although modern medicine has although modern medicine has adopted impressive technology, it adopted impressive technology, it still lags behind in interacting still lags behind in interacting with patients, managing with patients, managing information, and managing information, and managing overhead. overhead.

The millennial patient is The millennial patient is bewildered and angry with the bewildered and angry with the failure of medical services to use failure of medical services to use computers the way they are used computers the way they are used in everyday life. in everyday life. http://crossoverhealth.wordpress.com/http://crossoverhealth.wordpress.com/

Will there be aWill there be ashift in control?shift in control?

According to a recent count, there are According to a recent count, there are already 31 web sites for doctor already 31 web sites for doctor evaluations.evaluations.

What impact will this have on the What impact will this have on the doctor-patient relationship?doctor-patient relationship?

For some time, Chris Anderson has been For some time, Chris Anderson has been talking about the Long Tail Model of web talking about the Long Tail Model of web marketing; it also relates to health.marketing; it also relates to health.

Will these web Will these web sites serve the sites serve the long tail by long tail by providing providing services like services like online analyses, online analyses, wellness advice, wellness advice, professional professional health advisors, health advisors, and more and more competition?competition?

Increasingly the question is being asked, Increasingly the question is being asked, “Is hospital a place or a thing?”“Is hospital a place or a thing?”

Professional health Professional health care is being care is being provided at malls, provided at malls, pharmacies, pharmacies, worksites, etc.worksites, etc.

Perhaps the most radical answer is “The American Perhaps the most radical answer is “The American Well, which uses wireless communications to give Well, which uses wireless communications to give clients the opportunity to be “examined” anywhere clients the opportunity to be “examined” anywhere by an online physician with known qualifications. by an online physician with known qualifications. The World Health Care BlogThe World Health Care Blog - - www.worldhealthcareblog.org/www.worldhealthcareblog.org/

2008/05/07/the-new-place-for-health-care-is-everywhere/2008/05/07/the-new-place-for-health-care-is-everywhere/

We need to teach our clients We need to teach our clients more about how to search for, more about how to search for, evaluate, and use information,evaluate, and use information,

by introducing topics like RSS, social tagging, connotea, by introducing topics like RSS, social tagging, connotea, wikis, sharepoint, and information evaluation.wikis, sharepoint, and information evaluation.

Will disintermediation limit the effectiveness of this Will disintermediation limit the effectiveness of this information?information?

Perhaps the next piece to be Perhaps the next piece to be added will be virtual worlds.added will be virtual worlds.

Virtual worlds may fill the need for intermediation.Virtual worlds may fill the need for intermediation.

Second Life is a 3-dimensional, online, Second Life is a 3-dimensional, online, virtual world where the culture, virtual world where the culture, economy, buildings, and goods economy, buildings, and goods are all user created. are all user created. 

Some users are already using Second Some users are already using Second Life to deliver interactive health Life to deliver interactive health information.information.

What would be the role of virtual worlds?What would be the role of virtual worlds?

Virtual worlds provide an overlap between Virtual worlds provide an overlap between real life and internet space.real life and internet space.

Second Life can be used to create an Second Life can be used to create an immersive teaching environment, where immersive teaching environment, where intermediaries can help clients find intermediaries can help clients find information.information.

The avatar provides more of a sense of The avatar provides more of a sense of personal presence than other web media.personal presence than other web media.

The avatar also provides enough The avatar also provides enough anonymity to allow people to access topics anonymity to allow people to access topics that would be embarrassing in real life, that would be embarrassing in real life, ranging from sex to sex education.ranging from sex to sex education.

Healthinfo Island Healthinfo Island on Second Lifeon Second Life

HealthInfo Island is funded by a grant from the HealthInfo Island is funded by a grant from the National Network of the National Library of National Network of the National Library of Medicine (NN/NLM) and administered by the Medicine (NN/NLM) and administered by the Alliance Library System of East Peoria, Illinois.Alliance Library System of East Peoria, Illinois.

The goal is to work with various health support The goal is to work with various health support groups to provide online health information.groups to provide online health information.

Many groups Many groups already have a already have a presence on presence on the island, the island, includingincluding

The Ivy Tech Community College nursing program The Ivy Tech Community College nursing program (Fort Wayne, Indiana).(Fort Wayne, Indiana).

National Library of Medicine.National Library of Medicine.

The Karolinska Institute, Stockholm, Sweden.The Karolinska Institute, Stockholm, Sweden.

(The CDC has an island next door.)(The CDC has an island next door.)

slhealthy.wetpaint.com/page/HealthInfo+Island

The Alzheimer's Disease Display is created by The Alzheimer's Disease Display is created by Medium Helvetic for the Toronto Alzheimer Medium Helvetic for the Toronto Alzheimer Society.Society.

There are many other health organizations There are many other health organizations in Second Life. The UC Davis medical in Second Life. The UC Davis medical center has created a site for Virtual center has created a site for Virtual HallucinationsHallucinations

Will this make medical Will this make medical staff better able to staff better able to recognize real problems?recognize real problems?

Britain’s National Health Service Second Britain’s National Health Service Second Life has built an entire virtual hospital.Life has built an entire virtual hospital.((http://www.washingtonpost.com/wp-dyn/content/video/20http://www.washingtonpost.com/wp-dyn/content/video/2007/10/05/VI2007100501307.html)07/10/05/VI2007100501307.html)

Can this be Can this be useful for useful for medical medical education?education?

How much How much can you can you teach with teach with simulations?simulations?

At the heart murmur sim, you can listen At the heart murmur sim, you can listen to actual heart murmurs.to actual heart murmurs.

Are the global Are the global health standards health standards sufficiently sufficiently uniform?uniform?

Is the definition of Is the definition of high blood high blood pressure the pressure the same in different same in different countries?countries?

We are still a long way from Star Trek’s We are still a long way from Star Trek’s holodeck, but perhaps we are moving in holodeck, but perhaps we are moving in that direction.that direction.

The most important advantage of virtual worlds is that they provide a space where educators can guide clients to create a more effective experience. The most important advantage of virtual worlds is that they provide a space where educators can guide clients to create a more effective experience.

Or, it may be too late for virtual world sites to gain traction in a crowded field. Or, it may be too late for virtual world sites to gain traction in a crowded field.

How can we summarize the current state of web How can we summarize the current state of web health information?health information?

The main driving forces are the desire of The main driving forces are the desire of the tech-savvy Boomer generation for the tech-savvy Boomer generation for health information and the large number health information and the large number of ad dollars available.of ad dollars available.

The role of virtual worlds, like Second Life, The role of virtual worlds, like Second Life, is not yet clear. is not yet clear.

Sherry Turkle says it is more important to Sherry Turkle says it is more important to ask how these sites are “...changing the ask how these sites are “...changing the way we deal with one another, raise our way we deal with one another, raise our children and think about ourselves.” children and think about ourselves.”

alumweb.mit.edu/opendoor/200307/turkle.shtmlalumweb.mit.edu/opendoor/200307/turkle.shtml

Dynamism of a Cyclist - Umberto BoccioniDynamism of a Cyclist - Umberto Boccioni

We are in a period of very rapid change!We are in a period of very rapid change!

Like the Italian Futurists (1910), we Like the Italian Futurists (1910), we must adjust to speed!must adjust to speed!

Acknowledgements and ThanksAcknowledgements and Thanks

I wish to acknowledge I wish to acknowledge many helpful talks many helpful talks with Carol Perryman with Carol Perryman and Namro Orman, and Namro Orman, my guides to health my guides to health information in Second information in Second Life,Life,

and I wish to thank you and I wish to thank you for listening.for listening.