Comments on: Can Web 2.0 Trump eHealth Interoperability Issues?

By: Denise Silber

Denise Silber — Thu, 25 Feb 2010 18:33:23 +0000

Thank you for all the great comments. I’m glad that the subject is of interest. And they are very valid questions you raise. But given the interest you’ve expressed, it sort of comforts my albeit optimistic view. What I have found is that my optimism proves realistic, it’s just the amount of time required that I underestimate!

By: adesina

adesina — Thu, 25 Feb 2010 17:53:56 +0000

Web 2.0 as a flattening technology for e-participation is a social phenomenon but its use for eHealth communication and for healthcare information exchange is still at its infancy. Progress in consumer/citizen/patients-centric Web 2.0 applications is encouraging but the closure of Revolution PHR programme in the US is a clog in the wheel. Consumers reluctance to take ownership and physicians inertia were identified as reasons for closure.
This brings an important point to the fore. Physicians’ reluctance to adopt Web 2.0, I argue here could be a pointer to its future adoption in healthcare organizations. Traditional aversion to technology in healthcare coupled with obvious commercial push could constrain mainstream adoption in healthcare, I argue.
With respect to emerging markets, we have to understand that standards define innovation, enterprises and industry. If many developing countries are lacking in capacity to tap into these opportunities afforded by extant standards, sustainability of eHealth programmes will be in jeopardy, I am afraid. Already, traditional eHealth technologies are not sustainable in many projects especially in African countries. So a key question is what difference will Web 2.0 make if global eHealth standard setting is not inclusive and empowering?

By: Niklas Lindblom

Niklas Lindblom — Thu, 25 Feb 2010 17:36:04 +0000

Considering the huge outreach of services such as Facebook and Twitter, Health 2.0 services are likely to reach a similar audience, which makes security and privacy standards paramount. Are there any ethical issues in patients more or less putting their healthcare information on the Web? Further, I, and many others with me, join in your call Denise. Digitization and harmonization of patient data are big parts of bringing eHealth development forward and this must come from inside the healthcare industry. Any attempts from individuals to create online health records should also ensuring that interconnectability and interoperability with healthcare systems are viable, otherwise it would just result in a patient’s medical profile floating around the Web… // Niklas

By: Keith W Boone

Keith W Boone — Thu, 25 Feb 2010 17:28:47 +0000

Denise:

Web 2.0 still has a way to go to make it possible to connect disparate communities. I use a lot of these technologies in my own communications, and have tied many of them together successfully. I’m on Facebook, Twitter, Linked In, Blogspot, Google Groups and using Google Maps for example.

I still need additional tools to make my twitter posts update on Facebook, or to read updates to a Google Map and tweet them out to others. Turning all of this information into computable knowledge is still an even harder task, because of the lack of standardization. Yes, we are all using HTML or even XHTML to put content out there, or XML and Atom to feed it. But I cannot compute with it yet the way I want to.

I agree with your final point. Making the information electronically accessible to patients is an absolutely necessary first step. The next steps beyond that are to make the semantics of that information computable, and until that is done, Web 2.0 will only be able to operate on text. Text alone can provide great utility, but I know from 10 years working on natural language processing applications that it is just not the same as computable semantics.

By: Mattias Ganslandt

Mattias Ganslandt — Thu, 25 Feb 2010 16:47:15 +0000

Denise, I would like to stress the distinction between information production and medical evidence in this context. Even though I am sympathetic to a patient-oriented health care it is vital that data is collected and analyzed in a systematic way. There is no guarantee that a decentralized and spontaneous production of data will eventually shed light on statistically significant relationships. And as anyone dealing with large amounts of data and information could tell; producing knowledge is costly and erasing false information and misperceptions could be even more cumbersome. Hence, the introduction of Health 2.0 services may involve important trade-offs (costs and benefits). Not to mention the fact that the group of patients in greatest need of health care (elderly) may not be able to or have difficulties to use web 2.0 services. I like your enthusiasm though. /Mattias

By: adesina

adesina — Thu, 25 Feb 2010 16:28:49 +0000

Denise, eHealth is not about technical standardization alone but it requires institutional, human and social platforms for integration. A new report on eHealth in OECD has also identified lack of universal standards as a major constraint to impactful eHealth adoption and diffusion.
This also constrains trans-border eHealth infrastructure development.
At the global level, currently, efforts are lacking to integrate developing countries into any eHealth standard development projects. This requires urgent attention in the age of healthcare globalization.

By: Ajit Jaokar

Ajit Jaokar — Thu, 25 Feb 2010 16:08:28 +0000

Hello Denise

Here are my initial ideas. I have also been a keen observer/student of web 2.0 principles to other domains(in my case, originally mobile). So, I agree that the principles definately apply and there is a lot to be gained and learned by the LITE way in which web 2.0 is implemented.

As you rightly point out, it does not need ‘standards’ it simply goes about solving specific problems

Now, my two thoughts are:

a) The root principle of Web 2.0 is ‘harnessing collective intelligence’ – so in this case, do you think it will apply to healthcare considering privacy issues and the issue that providers could acquire metadata

b) If you consider the wider issue of e-health, we incorporate many aspects. ex
Electronic Health Records, Telemedicine, Consumer Health Informatics (or citizen-oriented information provision), Virtual healthcare teams, mHealth or m-Health, Healthcare Information Systems (among others)
which of these areas could be impacted more by the web 2.0 principles?

Also I will have a look at the Norwegian report

many thanks
kind rgds
Ajit

By: Mattias Ganslandt

Mattias Ganslandt — Thu, 25 Feb 2010 15:59:03 +0000

Denise, A very optimistic view indeed! There are several issues worth discussing. First and foremost, the increased use of standardized information has a great potential to improve health care even at a very basic level (far more basic than web 2.0). Perhaps most importantly allowing for systematic research on large populations also at an international level. Evidence from the US also suggests that standardized (evidence-based) information routines and checklists in clinical care can greatly reduce risks and inadequate treatment. /Mattias