Web, Medicine and Health 2.0

WEB 2.0

I’m sure most of you have heard of Web 2.0.  Web 2.0 is the second generation of Internet use.  The most important aspect of Web 2.0 is that it focuses on interaction between web users themselves and web users and publishers.  User-created content takes on much more importance.

Some of the most important Web 2.0 technologies are blogs, RSS feeds, video hosts like YouTube, wikis, social networking sites like Facebook or MySpace, and web-based community sites.

MEDICINE 2.0

Medicine 2.0 is obviously the combination of medicine and Web 2.0 technologies.  It’s basically the most recent version of cyberMedicine.  Web users collaborate to exchange and share information to better their health care experience.

Medicine 2.0 involves a huge collection of health-related social networking sites.  There are waaay too many for me to look all of them up, so I’m not going to bother including any.  If there is a specific health issue you want to find a social networking site for, just look it up.  You’ll probably find something.  Or figure out how to make one yourself.  That’s what Medicine 2.0 is all about, using the web to find or create the content you want and need.

RSS feeds are basically a collection of updates from sites you subscribe to.  Instead of having to go to a site and search for new information, the site sends you a list of what’s new.  This way, patients and doctors can both easily keep up to date with the newest information on any topic they want or need to know about.

Medical blogs are an important part of Medicine 2.0.  You and I are participating in Medicine 2.0 right now, by writing and reading this blog!

HEALTH 2.0

It’s kind of tricky to distinguish between Medicine 2.0 and Health 2.0.  Obviously, they are both based on interactive Web 2.0 technologies.  Apparently, there are a lot of different definitions of Health 2.0.  According to the Health 2.0 Conference website, like Medicine and Health 2.0 themselves, “defining Health2.0 is also a user-generated phenomenon.”  The definition you find depends on who wrote the site you look at.  Like the web itself, the definitions of Health 2.0 and Medicine 2.0 are always changing based on users.

According to a study on the subject, Health 2.0 and Medicine 2.0 have five important aspects in common.

They both:

1. have the same people involved (doctors, patients, etc)
2. have an impact on traditional medicine
3. are able to personalize health care
4. promote medical education
5. have issues that come from method and tools used (like inaccuracy in user-generated content)

(If you really want a few concrete definitions, the Health 2.0 Conference About Page has its own interpretation and links to others.  A bi-weekly blog carnival called Medicine 2.0 has its own distinction between the two.)

WHY IS THIS IMPORTANT?

Medicine 2.0 is important because it is moving the focus of health care away from doctors and towards patients.  It lets patients get together and talk about problems they’ve had and the treatments they’ve found without having to go anywhere to do it.  Patients are becoming more and more responsible for their own quality of health care and finding information to make the best of their health.

LINKS

I mentioned a bi-weekly “blog carnival” earlier in this post.  It’s called Medicine 2.0.  If you are interested in cyberMedicine (partcularly Medicine 2.0), check it out.  (The earlier link is directly to the 10th Edition, where the definition of Health 2.0 is.)

A New York Times blog about health-related social networking sites.  It contains links to a few particular sites.  There are more links in the comments at the bottom of the page.

Office of Telehealth

Telehealth

According to HRSA’s Office of Telehealth, telehealth is the blanket term that covers the use of both electronic and telecommunications technologies to support long-distance clinical health care. CyberMedicine is obviously an enormously important section of telehealth.

Telehealth Offices

The importance, potential and current limitations of telehealth have been largely recognized by the health care community.  Organizations from the Federal level to small businesses have created offices of telehealth.

HRSA Telehealth

The US Department of Heath Resources and Services Administration, HRSA, has an Office of Telehealth.  According to the Web site, their Office of Telehealth fosters partnerships both within HRSA and with other groups to create telehealth projects.  They administer telehealth grant programs.  They provide technical assistance and evaluate the use of telehealth technologies and programs.  They develope telehealth policy initiatives to improve access to quality health services.  HRSA Telehealth also promotes knowledge exchange about “best telehealth practices.”

Rochester General Hospital Office of Telehealth

Even hospitals have recognized the importance of telehealth.  Rochester General Hospital in the city of Rochester in upstate New York created its Office of Telehealth to increase access to specialists.  The office offers services for both in and out patients.  It offers specialty physician consults to other hospitals and clinics in surrounding rural areas where recruitment of highly specialized physicians has been a problem.

Small Organizations and Telehealth

Even small organizations like Home Health Visiting Nurses of Southern Maine have offices of telehealth.  The goal of HomeHealth’s Telehealth Services is to use cyberMedicine to provide interactive home healthcare at a lower cost.  They provide real-time “video visits” that lets patients see and hear the teleheath nurse.  The nurses perform medical assessments, monitor vital signs, evaluate wound status and provide self-care education.  The hope is that telehealth technology will help reduce patient hospitalization and improve the quality of life for chronic care patients.

Potential and the Importance of an Organized Approach

I think that the all-encompassing potential of telehealth, specifically cyberMedicine is pretty obvious.  It can and is being used to do everything from increase access to specialist healthcare to assisting patients in the home.  It has the potential to do great things.  There are also many limitations in the current system.  I think that the wide-spread attention and focus on telehealth will help further it.  I believe that an organized focus on telehealth and the technologies that make it possible, especially on the Federal level will allow for a much easier transition into a world where telehealth is used to its full potential.

Links

HRSA Telehealth

HomeHealth Telehealth Services

Rochester General Hospital Technology Brings Specialized Care Closer to Home

Article by Medical Director of the Office of Telehealth, Rochester General Hospital

Keep Your Own Health Records

What Are Personal Health Application Platforms?

A Personal Health Application (HPA) platform is a record system where you can keep a complete file of your own medical records for yourself.  They’re also called Personally Controlled Health Record systems.  They are secure, and unless you invite someone to, no one else can access or edit your medical profile.  The systems let you share your records with websites or individuals of your choice.  You also choose how much information you let them see.

Why Keep One?

PHA’s are a great example of what cyberMedicine can do to empower patients.  Initially you will have to go to your doctor to get copies of your records and dates of immunizations and whatnot, depending on the HPA, but after that, you own all of your information.  You choose where you go with it, who sees it, what they see and even what you put on your profile.

This marks a HUGE shift from doctor-oriented to patient-oriented heath care.

Is There a Downside?

Obviously, it can be dangerous to have such personal information floating around the internet.  The HPA’s all have security measures, but hackers are always out there.  Also, anyone can create a profile, so you don’t necessarily know who you are talking to, like on forums.  All the security measures in the world can’t stop someone from sharing their information with the wrong person.

What HPA’s Are There?

I signed up for one HPA, Microsoft’s HealthVault to check it out.  It was originally launched in October of 2007.  I picked this one because it has won a award for security.  There are TONS more out there though, so if you want to use one, shop around first. You have so many options. I just wouldn’t have the time to find all of them, let alone sign up for and write about them.

-Health Vault

You need a Windows Live ID to sign up for HealthVault, but as far as I can tell you don’t need to have Windows.  You just need a valid email address.  You choose when you start if you want are want a personal account or if you work within the health industry.  It only takes a few minutes to make the account.

–Security Measures

As I noticed while writing this post, they automatically log you out after 20 minutes of inactivity.  Traffic is encripted, and additional security and privacy measures are embeded.  They also do not link their advertising to the information on your profile, so it is less invasive.

–Overall Evaluation

Overall, HealthVault seems pretty user-friendly.  I like that they were awarded for their security measures, but I have seen skeptical reviews.  One deals with two lines in the service contract in particular:  You cannot “use the Service in a way that harms us or our affiliates, resellers, distributors, and/or vendors (collectively, the “Microsoft parties”), or any customer of a Microsoft party.”  The second is this: “We may use technology or other means to protect the Service, protect our customers, or stop you from breaching this Service Agreement.”  However, Microsoft clarifies this statement, saying, “These means may include, for example, filtering to stop spam or increase security.”

Either way, like I said, there are tons of HPA’s out there to choose from.  Do your research if you plan on using one.

Links

HealthVault

HealthQuack Blog about HealthVault security

HealthVault Review

CyberMedicine and Internet Access

The Problem of the “Digital Divide”

When people talk about the Internet and everything it can do, they usually don’t consider one big limitation- not everyone has internet access.

More and more companies are online; some are even entirely Internet-based.  More services are also being offered online.  Imagine how much you would miss if you couldn’t log on to the internet every day!  And of course, things like cyberMedicine are going to continue to grow, especially since it makes health care cheaper and easier.

There tends to be more white space in rural areas where there also tends to be more limited access to doctors and the Internet.  Partly because of that, it is extremely important to get more Americans access to the internet.

The lack of access is part of what is known as the “digital divide” that is growing between people who have access and knowledge of technology like the Internet and people who don’t.

A Solution

Television actually provides one really interesting possible solution to the internet access problem.

The way TV is broadcast now, there are “white spaces” in between the channels we see on our TV screens.  There tend to be more white space in rural areas (as much as 75 percent!) than there is in urban areas, but there are white spaces everywhere in the U.S.

These white spaces can actually be used to broadcast high speed Internet!

The FCC is going to vote on whether or not white spaces will be used for Internet access on this November 4, 2008.  If they vote yes, anyone across the country will have access to the Internet through their TV screens.

The chairman of the FCC, Kevin Martin endorsed the idea.  He said “white spaces can be used as long as it does not interfere with broadcasters.”  According to tests done by the FCC, it shouldn’t interfere with current TV broadcasts at all.  So hopefully on election day 2008, the FCC will vote in a new way to access the internet, while citizens are voting for the new president.

What You Can Do to Break the Digital Divide!

Tell the FCC to Open Up the Airwaves!

Sign Google’s Petition to the FCC!

or call congress! (this site helps you figure out who to call and gives you an idea of what to say!)

Or find some way to spread the word and tell people about the problem of internet access, like a youtube video!

Remember, you are helping break down the digital divide so every American can have equal opportunities in everything from communication to health care in this increasingly digital world!

Other Links

Save the Internet Blog

Free the Airwaves- Google’s advocate site

Article on InformationWeek.com- FCC Chairman backs use of white spaces

Patient-Doctor Relationship Podcast!

Check out my podcast about the effect of cyberMedicine on the relationships between patients and their doctors!

Legal Issues

There are a lot of legal issues when it comes to the practice medicine.  Those same issues, and new ones, are going to have to be addressed for cyberMedicine, and soon.

Licensing

Right now, health professionals are regulated by state laws. Obviously this is a problem because the internet crosses both state and national borders.

Consequences

We could see a lot of lawsuits in the near future. If cyberMedicine sites are considered to be practicing medicine, they need to be licensed. Since they are not (and can’t be right now because there is no way to license across state borders) they are practicing unlicensed medicine.

Website Liability

Federal law says that websites that link to content on other sites are not liable for the information on those sites. CyberMedicine sites that do that, or who run forums, should be free from liability issues. Sites that make their own content might not be.

Consequences

We could see content become less original (and possibly less helpful) if sites are worried about liability. We could also see sites shut down.

Malpractice Insurance

Malpractice Insurance is also written on a state-by-state basis, which will be a problem for physicians, especially as medicine on the web becomes more and more popular.

Consequences

Again, there could be a lot of lawsuits in the near future.  Some doctors might shun cyberMedicine all together if a new way to get malpractice insurance isn’t created.

What Needs to Be Addressed

The first big question right now is what in cyberMedicine equates to the practice of medicine, especially when it comes to information-sharing.

Another is how are we going to license physicians who give information online? Should we change the way all health professionals get licenses? Or should we require an additional license to practice medicine online? Should we make international licensing? (These questions all apply to malpractice insurance for doctors as well.)

A third question is how liable are sites for the information on them?  What is going to happen to sites that are liable?  What could be considered problematic information on those sites?

Conclusion

These are only a few issues involved in cyberMedicine. Obviously, the Medical and Medical Law communities have a lot of thought and debating to do before cyberMedicine can reach its full potential. I think that we are going to see some really interesting court cases shape the way we use the internet for health information and communication with our doctors.

Source:

The Legal Column: Legal Pitfalls of Cybermedicine

Kwikmed.com and Blurring Distinctions

A big concern about cyberMedicine is that websites often blur the distinctions between the traditional doctor’s office, pharmacies and drug manufacturer.

Kwikmed.com is the first and only site currently licensed to prescribe medication online, and a great example of this concern.

To register, you have to set up a short profile (that includes your shipping and billing addresses.) You can also sign up for a newsletter, “tip of the week” and discounts through email.  After you register and log in, you can pick a medication to ask for, fill out an order form and an online consultation.

If you even glance at the home page, however, it’s hard to miss the blatant advertising.  The site only carries “medications that can be safely prescribed without a face-to-face evaluation and delivered at a significant cost savings,” which translates to a total of five medications.

The site basically acts as a big advertisement and distribution method for those medications.  Patients don’t even have to talk directly with doctors to get medication, they basically fill out a request form that doctors look at.

Links

Warnings about CyberMedicine from Missouri Law Professor

Kwikmed.com

Expert Patients

Last week I talked a little about how information on the web has led to the creation of “expert patients” and how that has had a positive effect on patients.

Of course, there is a downside and lots of potential for abuse.

There are tons of places people can go for advice (like WebMD) but we cannot always tell who is giving the advice or how helpful it will be.  People react differently to different treatments, and many people are taking a cocktail of pills that could interact poorly with a new drug that works for someone else.

The “like-minded patient” giving advice could even be someone from a pharmaceutical company promoting a drug.

The anonymity of the web could lead to a lot of exploitation and poor medical treatment, so we always have to be careful and take whatever we find with a grain of salt before we take that spoonful of medicine.