Social Networking and Teaching with Social Technology

1. Social Networking and Teaching with Social Technology • or, how does social networking impact health education? • Harry E. Pence • Distinguished Teaching Professor • Dept. of Chemistry and Biochemistry • SUNY Oneonta http://www.wrapables.com/

2. The evolution of access to patient information. • Where did a patient traditionally get information? informative advertisements the friendly doctor Prominent medical journals

3. This changed with the advent of the Internet. • You might call this Web 1.0. online support groups web pages

4. Two major web sites ushered in the e-Patient movement in the mid-1990’s. • PubMed provides free access to the MEDLINE database of more than 17,000,000 biomedical research articles. WebMD is still the most popular U.S. health portal. It provides health information, a symptom checklist, personal information storage, pharmacy information, and physician blogs.

5. Patients used message boards, distribution lists, and blogs to share information about their symptoms, diagnosis, and treatment. www.manzanitavillage. org/coaching/fr_coaching.html The most popular sites are patient created. Patients with similar diseases not only offer empathy and suggestions based on shared experience, often they can supplement doctors’ opinions.

6. Doctors began to meet with patients who had already done extensive web research about their diagnosis and/or treatment. http://www.uniongas.com/Business /otherci/energyefficiency/segments /institution.asp “The old Industrial Age paradigm, in which health professionals were the exclusive source of knowledge, is gradually giving way to a new information age worldview.” Tom Ferguson, MD

7. Since 2006, increasing numbers of online health sites have been created that incorporated Web 2.0 technologies such as wikis, mash-ups, blogs, and video. I would argue that the key component is interactive, user-generated content , i.e. social networking applied to health. Do physicians like the informed patient? Some do; some don’t. If the doctor objects to patient research, patients either go elsewhere or hide their research! Where do patients get information in the Web 2.0 World?

8. A recent survey (“How America Searches: Health and Wellness.” Jan. 2008) asked this question. The Web (59%) was slightly more popular than doctors (55%), and far ahead of pharmacists (18%) and nurses (15%). Online is more popular with younger patients. Logo from Health information Management Program - Univ. of Victoria.

9. Major Health 2.0 Web Sites In addition to the old standards, like WebMD and PubMed, we now have new wikis, blogs, medical search engines, and portals. • AthenaHealth focuses on billing and insurance regulations.

10. Specialized Health Search Engines are multiplying. • Healia is a very powerful health search engine. • MEDgle searches symptoms, diagnoses, physicians, drugs, and medical procedures. • iGuard.org focuses on the safety of perscription medicines. • Enurgi aims to help elderly and disabled individuals. • Healthline and Aetna have combined to create a personalized search engine.

11. Some Major Health 2.0 Portals Each one hopes to be the next health related MySpace!

12. According to Manhattan Research, some 9.9 million consumers regularly post health information online and some sites focus on capturing those experiences. • All three of the big search sites are now involved in health information.

13. What will it take for one of these portals to become the “Health MySpace?” • My guess is that e-patients will be more receptive to sites that help them to not just access content, but also to connect and collaborate with others. • It is increasingly hard for new sites to find a niche to be filled. • Since many people use a search engine to find a site, Google seems to have a built-in advantage.

14. Do Doctors use social networking? According to a Manhattan Research white paper: almost 80,000 U.S. physicians currently participate in online physician communities. The online physicians tend to be older than average; Westerners are more likely than those in the Northeast; and females are significantly more likely than males. There is a nice ranking (google, technorati, etc.) of the top 100 health care blogs at http://www.edrugsearch.com/top100/

15. Why have so many health sites been created in such a short time? The Baby Boomer generation is reaching the point where they are very concerned about health and fitness. Boomers recognize that they will have 20-30 years of life after they retire. Broadband access and site creation tools are becoming much more widely used. Some vendors see a need to be served; others see an abundant cash flow. Accuracy and privacy are major concerns.

16. Studies report that most of the online health information is accurate, and most errors are quickly corrected. Patients who live with chronic diseases often know more about them than their doctors. Patients with serious diseases are more concerned with getting information than with maintaining their privacy. (Ref:The Economist, 4/11/2008, http://www.economist.com/ science/tq/displaystory.cfm?story_id=10676339 Reputable sites conform to the Health on the Net Honor Codedescribed at(http://www.hon.ch/HONcode/Conduct.html)

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

18. Where will potential users learn how to use these resources and which are best? • Let me highlight just a few possible changes.

19. The Millenial Patient Scott Shreeve, MD says that although modern medicine has adopted impressive technology, it still lags behind in interacting with patients, managing information, and managing overhead. The millennial patient is bewildered and angry with the failure of medical services to use computers the way they are used in everyday life. http://crossoverhealth.wordpress.com/ Will there be a shift in control?

20. According to a recent count, there are already 31 web sites for doctor evaluations. • What impact will this have on the doctor-patient relationship?

21. For some time, Chris Anderson has been talking about the Long Tail Model of web marketing; it also relates to health. Will these web sites serve the long tail by providing services like online analyses, wellness advice, professional health advisors, and more competition?

22. Increasingly the question is being asked, “Is hospital a place or a thing?” Perhaps the most radical answer is “The American Well, which uses wireless communications to give clients the opportunity to be “examined” anywhere by an online physician with known qualifications. The World Health Care Blog - www.worldhealthcareblog.org/ 2008/05/07/the-new-place-for-health-care-is-everywhere/ Professional health care is being provided at malls, pharmacies, worksites, etc.

23. We need to teach our clients more about how to search for, evaluate, and use information, • by introducing topics like RSS, social tagging, connotea, wikis, sharepoint, and information evaluation. • Will disintermediation limit the effectiveness of this information?

24. Perhaps the next piece to be added will be virtual worlds. • Virtual worlds may fill the need for intermediation.

25. What would be the role of virtual worlds? Second Life is a 3-dimensional, online, virtual world where the culture, economy, buildings, and goods are all user created.  Some users are already using Second Life to deliver interactive health information.

26. Virtual worlds provide an overlap between real life and internet space. Second Life can be used to create an immersive teaching environment, where intermediaries can help clients find information. The avatar provides more of a sense of personal presence than other web media. The avatar also provides enough anonymity to allow people to access topics that would be embarrassing in real life, ranging from sex to sex education.

27. Healthinfo Island on Second Life HealthInfo Island is funded by a grant from the National Network of the National Library of Medicine (NN/NLM) and administered by the Alliance Library System of East Peoria, Illinois. The goal is to work with various health support groups to provide online health information.

28. Many groups already have a presence on the island, including The Ivy Tech Community College nursing program (Fort Wayne, Indiana). National Library of Medicine. The Karolinska Institute, Stockholm, Sweden. (The CDC has an island next door.) slhealthy.wetpaint.com/page/HealthInfo+Island

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

30. There are many other health organizations in Second Life. The UC Davis medical center has created a site for Virtual Hallucinations • Will this make medical staff better able to recognize real problems?

31. Britain’s National Health Service Second Life has built an entire virtual hospital.(http://www.washingtonpost.com/wp-dyn/content/video/2007/10/05/VI2007100501307.html) Can this be useful for medical education? How much can you teach with simulations?

32. At the heart murmur sim, you can listen to actual heart murmurs. • Are the global health standards sufficiently uniform? • Is the definition of high blood pressure the same in different countries?

33. We are still a long way from Star Trek’s holodeck, but perhaps we are moving in 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. • Or, it may be too late for virtual world sites to gain traction in a crowded field.

34. How can we summarize the current state of web health information? • The main driving forces are the desire of the tech-savvy Boomer generation for health information and the large number of ad dollars available. • The role of virtual worlds, like Second Life, is not yet clear. • Sherry Turkle says it is more important to ask how these sites are “...changing the way we deal with one another, raise our children and think about ourselves.” • alumweb.mit.edu/opendoor/200307/turkle.shtml

35. We are in a period of very rapid change! • Dynamism of a Cyclist - Umberto Boccioni Like the Italian Futurists (1910), we must adjust to speed!

36. Acknowledgements and Thanks • I wish to acknowledge many helpful talks with Carol Perryman and Namro Orman, my guides to health information in Second Life, • and I wish to thank you for listening.