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Primary Psychiatry. 2007;14(8):31-34
Dr. Luo is assistant clinical professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California in Los Angeles; past president of the American Association for Technology in Psychiatry (AATP) in New York City; and Gores Informatics Advocacy chair at the AATP.
Disclosure: Dr. Luo reports no affiliation with or financial interest in any organization that may pose a conflict of interest.
The Internet is a vast array of information, Web sites, and Web pages interconnected by hypertext code to provide users with relevant information. The Pew Internet & American Life Project conducted a telephone survey in 2002 which determined that 80% of respondents have searched for health information on the Internet.1 Netcraft surveyed Web servers, discovering in July 2007 that there were an additional 3.62 million Web sites added since June 2007, with a total of approximately 126 million Web sites.2 Companies such as Yahoo3 and Google4 have made their fortunes connecting users to relevant information on the Internet. Despite the advances of search technology, many new Web sites and companies have failed, taking their information offline.
The Internet Archive5 is one organization working to preserve such information for future generations to come. However, success and longevity on the Internet today has been attributed to whether companies embrace the concept of Web 2.0, a different model of Internet.6 With so many Web sites regarding health information, the growth and longevity of these companies and their Web sites may be dependent on how they have adopted the Web 2.0 paradigm, known informally as Health 2.0.
Web 2.0
The birth of the concept of Web 2.0 was credited to a conference meeting between MediaLive International and O’Reilly,6 a well-known Internet pioneer and publisher of widely adopted technical books. There are several principles to the Web 2.0 concept, the first being the “Web as a platform.” This principle is best understood in that the Web is not merely a group of interconnected computers in a network, but a breeding ground where new ideas are discovered or created. O’Reilly uses a comparison between Netscape and Google to illustrate this point. Netscape ultimately was a company that sold software and hardware, namely computer servers and Web browsers, whereas Google is a search service that utilizes those same computers and Web browsers, but its database of specialized information serves to connect the user to his or her Online experience. Although Netscape was a pioneering company when the Internet was launched, Google, with its Web 2.0 philosophy, certainly has achieved Internet dominance.
Another important principle of Web 2.0 is that the service automatically gets better the more people use it. An example of such a company and philosophy of distribution on the Internet is BitTorrent,7 which has developed a decentralized mechanism to distribute electronic information such as movies, software, and music over the Internet. Previously, it was known more for its use by those in the Internet underground to illegally share movies and pirated software, but nowadays it is being embraced by the movie and software industry as a legitimate distribution mechanism. Instead of downloading a video clip from a Web site server, which limits the numbers of users at one time who can download the clip, the BitTorrent7 client software reads a “torrent” file, which identifies other computers on the Internet that have pieces of the desired video clip. Each computer on the Internet using BitTorrent then passes varying pieces of the video clip until each computer eventually is able to put together the entire clip. Even if the downloading process is interrupted, BitTorrent software can start up from where it left off, avoiding frustrations with “wasting” downloading time since pieces are still usable. In this mechanism, the number of users who can download the clip via BitTorrent is empowered and increased by the more people who use this service, and each person on the Internet has something of value to contribute. It is conceivable in that the healthcare publishing industry would distribute multi-media–rich electronic healthcare journals with this method in particular because even with fast broadband Internet such as DSL and cable, it may take a bit of time to download video presentations of grand rounds recorded at high-definition video quality.
In a similar vein, another principle of Web 2.0 is the principle of harnessing the collective intelligence. Companies such as Amazon and eBay already embody this process where the shopping experience is influenced by the respective product as well as seller reviews and ratings entered by users into the Web site database. Wikipedia,8 an Online encyclopedia, takes this process further by providing a medium and resources where all of the site users have the opportunity to contribute to the encyclopedia by editing and adding information. Consumer physician rating Web sites such as RateMD,9 Healthgrades,10 DoctorScorecard,11 LocateADoc,12 NDDB,13 and MDJunction,14 are beginning to gain usage by patients to find doctors. Certainly, these Web sites exist with some controversy as a disgruntled patient may wish to damage the reputation of the physician with negative comments; however, consumers often struggle with how to find a good doctor much as they search to find a good espresso coffee maker on the Internet. Healthgrades incorporates information from state medical boards and federal disciplinary actions. MDJunction also provides Online support groups for patients in addition to physician reviews and recommendations. DoctorScorecard provides a mechanism for physicians to respond to their reviews and will actually delete negative reviews if they were felt to be unhelpful.
Medical information is also beginning to endorse the collective knowledge process with Wiki Books.15 There is an open textbook of psychiatry16 on Wiki Books, but it certainly is in need of a large amount of contributions. The Open Textbook Project has announced its project, but is still working on software tools for collaboration.17 Connexions18 is a Website that provides an environment for collaboratively developing, sharing, and rapidly sharing scholarly content on the Web. The Public Library of Science is a non-profit organization which publishes medical literature using the open-access model, allowing anyone to read, download, copy, distribute, and use its content in any way.19 Open Educational Resources Commons20 is a site that is devoted to teachers and professors, who can share course materials, collaborate, and access materials using Web 2.0 features such as tags. This process of creating shared and open-access materials mirrors the open-source software.
Sharing resources via tags is a key feature of Web 2.0, as exemplified by Web sites such as Del.icio.us21 and Flickr.22 With del.icio.us, members “tag” useful Web sites with key words, such as “psychiatry,” “palm software,” or “mental health,” creating a bookmark. Users can subscribe to keyword tags, and therefore, will be informed when a Web site is tagged that fits the description. Members can also create their own network of other del.icio.us users, and thereby share bookmarks in a more constrained fashion. Digg is another popular site that works in a similar way.23 Digg members can tag news sites, videos, and podcasts.
For example, a podcast on depression conducted by Epocrates Insights24 is then “dugg” by a user and shared within the Digg community. Other Digg members can also “digg” the podcast, which increases its ranking on searches, helping Web site visitors to find useful and popular podcasts, news, and videos.
Real simple syndication (RSS) is another way that content is shared with subscriptions to deliver news and other information in a push direction. The primary advantage of RSS is that when there is a change in the Web site or a new podcast, the subscriber is notified and provided a quick link to access the new information. The American Association for Technology in Psychiatry Interactive News Web site is a dynamic forum built via a collection of RSS feeds from various sources.25 Patients can create subscriptions to blogs of other patients or on disease topics, and physicians using an RSS reader can organize their Web site reading based on selected topics or sites, creating a highly customized menu of information.
Even search engines are being specialized for health care, such as Medstory,26 Healthline,27 SearchMedica,28 and Healia.29 Medstory indicates that they attempt to synthesize the meaning of every user search in the context of health and medicine, and then share this knowledge with the user to help refine and guide his or her search. Although the mechanism of how the company is able to improve searches is not clearly outlined, it likely involves some artificial intelligence to refine the search. Healthline uses a taxonomy-driven search platform to provide consumers and business partners with a portfolio of Online health search, content, and navigation services. The “semantic taxonomy” is built from multiple medical databases and connects interrelated concepts to provide a semantic organization and contextual presentation of health-related information. SearchMedica uses expertise from Consultant,30 and its editors, to search on well-known, credible journals, systematic reviews, clinical trials, and evidence-based articles. Healia also uses semantic technology to guide searches via health vocabularies of health-related concepts, similar and more general concepts, and more specific search terms and concepts when appropriate. Eurekster has created a hybrid Web 2.0 product called a “swicki,” which is a cross between a search engine and wikipedia.31 For example, if a swicki is created on the topic of treatment-refractory depression, users can modify the Web sites, shared tags, and links on that topic. The swicki can also be delivered by an RSS feed so that any modifications can be highlighted quickly.
Social networking sites as described in a recent Tech Advisor column32 also exemplify the spirit of Web 2.0, with goals of collaboration, sharing resources, and making new connections. Web logs provide not only an outlet for opinion and experience, but now serve as portals of news and communication wherein comments left by readers are an integral part of the social discussion process. The number of professional and patient-centered healthcare social-networking Web sites has doubled since that column32 was written, with certainly more sites with hybrid features to come.
Conclusion
The spirit of Web 2.0 in the healthcare industry is that the technologies encourage the social aspect of sharing resources, whether a bookmark or the actual content itself. Users are active participants and are actually co-developers of content, resource lists, or whatever that Web site has to offer. In many ways, Web 2.0 is part of the evolution of the Internet. In the early days, the Internet was primarily a connected collection of Web pages with an overwhelming amount of content to sift through to find relevant information. Today, with the social fabric and process, users can find and contribute to information in an even larger pool. Health 2.0 has become the new darling of Internet health care, with an inaugural meeting in September 2007 in San Francisco.33 PP
References
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2. Netcraft. July 2007 Web Server Survey. Available at: http://news.netcraft.com/archives/web_server_survey.html. Accessed July 7, 2007.
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32. Luo JS. Social networking: now professionally ready. Primary Psychiatry. 2007;14(2):21-24.
33. Health 2.0 conference. Available at: www.health2con.com. Accessed July 11, 2007.
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