Wikis — collaborative websites to which anyone can contribute — are powerful tools for education. The most popular Wiki is Wikipedia.org, a public encyclopedia, which as of this writing has 2,377,813 English articles.
One potential problem with Wikipedia is that medical articles aren't peer reviewed by authorities with a medical background. (Some might argue that this is actually an important feature of Wikipedia, and allowing anyone to comment on any topic is essential to Wikipedia's egalitarian nature.) The best known medical wiki, Ask Dr. Wiki, solves this problem by requiring all contributors to prove they have a medical degree before they can contribute.
I recently decided to start a new medical wiki — The Efficient MD Wiki, focused on productivity tips for doctors — and I took this opportunity to review some of the available wiki platforms and hosting services. It was a daunting task. I'll share my experiences here for those interested in starting their own wiki.
(Please note these experiences are my own, and I encourage anyone to comment and argue for/against the various wiki platforms.)
I narrowed my choices down to four platforms/hosting services:
Wikia. This platform is a free hosting service for wikis based on the MediaWiki software package, which is also the foundation for Wikipedia. The familiar MediaWiki package, however, also had certain disadvantages. Chief among them was the likelihood that the nonintuitive wiki markup language would discourage users unfamiliar with it from contributing.
Google Sites. The newest entry to the world of wikis, Google Sites initially looked promising. After setting up a site and experimenting, however, it was clear that the Google Sites was too new and lacked too many features to be usable. For example, the invitation and signin process was cumbersome, and anonymous edits of the wiki weren't allowed. (Knowing Google, I expect later version to be more polished.)
PBWiki. PBwiki also initially looked promising. PBWiki 2.0 was released as I was creating a test wiki. The new version didn't allow anonymous editing, however, and I had some criticisms of the wiki's layout, so I eventually decided not to use it.
Wetpaint. Wetpaint was first suggested when I asked for wiki recommendations on Twitter. I hadn't heard of it before. The Wetpaint platform has numerous advantages. The services are free, the layout is readable, anonymous posting is allowed, and — most importantly — its social networking features are more developed than any other wiki I tested. A major disadvantage was the disruptive presence of Google ads in the sidebar, but the ads can be disabled for educational wikis (if you ask).
The Efficient MD wiki is at wiki.efficientmd.com. Thanks for your contributions, and please let me know what you think.
I'm going to talk briefly about the disruptive potential of online communities of physicians and patients.
These online communities are an big part of what people have called "Health 2.0." Of course, this is just a buzzword, like "Web 2.0," but it's a buzzword that means something.
Early this month the Economist had an article about Health 2.0, which they defined as "user generated healthcare." In Health 2.0 communities, the content and value is not generated by outside experts, but by the users themselves, by healthcare providers and patients, who interact to share information and insights.
These online communities may be very different from one another -- and I'll give you some examples of them in a minute -- but they all have a couple of things in common: they're all public, collaborative, and simple to use. And this combination can be very powerful and disruptive.
For example, there's a website called Wikipedia which is perhaps the best example of a community that's a major source of health information for a lot of people. If you haven't seen it, Wikipedia is a free online version of an encyclopedia that anyone in the world with an internet connection can read and edit. I'll say that again -- anyone in the world can read it and edit it.
This idea seemed crazy at first and still seems kind of crazy, but it actually seems to work. Wikipedia is now 15 times as large as the entire Encyclopedia Britannica. And partly because of Wikipedia, very few people read the Encyclopedia Britannica anymore.
And what's written on Wikipedia definitely matters. Wikipedia is one of the top ten websites worldwide. Wikipedia is often one of the first places people go if they're diagnosed with a new disease, or if they want to research a person or a corporation. The definitions on Wikipedia are often near the top of any Google search.
But again, it's amazing that Wikipedia works at all, because anyone with an internet connection can change any of the definitions. And that's potentially very scary.
But the system works because it's self policing -- errors are picked up and changed by the users. But of course that still leaves some potential for significant inaccuracies and abuse.
[The author Charles Stross points out that if you extrapolate from current trends in computing, sooner or later everyone in this room will have an entry on Wikipedia. Try to imagine what they might be like.]
I'm going to talk about some other Health 2.0 communities that have the potential to be as disruptive as Wikipedia.
For example, there's an online community for physicians called Sermo. Sermo was founded on the idea of information arbitrage, that there's valuable information locked in the heads of physicians, if you could only figure out a way to get to it.
The way Sermo works is this: physicians ask and answer anonymous questions, but some of the questions are also asked by firms. When physicians answer some of these questions, they get paid, but they don't know which questions will pay them. So the incentive is to answer as many questions as possible. Sermo is basically an experiment in classical conditioning, it mines physicians for information by turning them into compulsive gamblers and taking advantage of their desire to collaborate. And it works very well.
It's only about a year old but Sermo is the largest online network of physicians that's ever existed. Sermo is also partnering with the AMA and the FDA, who are interested in information from Sermo about the safety of medical products. Sermo may actually be a better way to encourage physicians to report problems with drugs and devices than the FDA's own website.
There are also many online communities for patients, including sites with names like Organized Wisdom, Revolution Health, and Patients Like Me. These sites offer a number of services. They function as support groups for people whose physicians may not know enough about their disease or who don't have the time to explain it. They also allow patients to share their collective insights with one another. And they allow them to rate different sources of health information on the web. Some people like to use the phrase that "people are the new algorithm."
And some of these sites also allow patients to rate their doctors, health systems, and health products. And this is potentially disruptive, but not necessarily in a bad way. If people can search on Google for a review of your organization as easily as they can search for a review of a toaster, that can be a powerful incentive to change for the better. But as with Wikipedia, there's obviously a potential for inaccuracy and abuse.
And finally, there's also thriving community of medical blogs, which are online interactive journals written by patients, physicians, and other health care professionals. Many healthcare blogs contain hidden gems of information. And there's a sustained level of discussion on blogs that's hard to find anywhere else.
For example, there's a blog called "Kevin, MD" which collects all the most interesting stories in the media in one place. There's a blog called "Running a Hospital" by the CEO of Beth Israel Deaconess in Boston. And the Wall Street Journal even now has it's own excellent Health Care Blog, which I recommend to anyone interested in the business of healthcare. And the interactive nature of blogs is essential, because sometimes the comments can be more interesting than the original posts themselves.
To summarize: technologies like Wikipedia, blogs, and online communities have the potential to dramatically change and improve communication in the healthcare industry.
In part 1, I introduced ways of searching for health information online and discussed Healthline's approach and the use of HealthMaps. In part 2, I discussed MedlinePlus and the individual web pages of physicians. In this part, I'll compare three other methods of searching for health information: UpToDate (a "top-down" approach), Google Search (a "bottom-up" approach), and Google Co-op (a "hybrid" approach).
UpToDate is a popular, frequently updated, online textbook of medicine for health care providers. It's unparalleled at giving a quick, high-level overview of many frequently encountered clinical situations and is widely used by physicians. UpToDate also offers a section of information designed for patients (which is less well-known). This information for patients on UpToDate is typically written by the same experts that write the reviews on the main site for health care providers. You might consider this a "top-down" approach to providing health information -- the site itself provides reviews of topics written by respected experts.
For example, our patient in part 1 with a kidney stone might navigate to UpToDate's "Table of contents for patient-level information," choose "kidney disease," then choose the section on "kidney stones." The reviews for patients on UpToDate are detailed and written at a high-level (which some people might find appealing and others might dislike), which reflects the main focus of UpToDate as a source of information for health care providers.
In contrast to the "top-down" approach of UpToDate, the search engine Google provides a "bottom-up" approach. Rather than producing it's own content, Google provides a list of links chosen based upon an automated method which provides a ranking of quality. If the patient with a kidney stone in part 1 searches for "kidney stones" in Google, the first link provided is a review from the National Institutes of Health. The second is the review from Wikipedia (a public encyclopedia to which anyone can contribute). While Google typically provides relevant, high-quality results, the links provided are not necessarily the most authoritative (take Wikipedia, for example) or safe (see McAfee Siteadvisor's analysis of the Safety of Internet Search Engines).
Google Co-op, a "hybrid" approach, is an attempt to address these concerns. Google Co-op combines the "bottom-up" search results from Google with the "top-down" expertise of various organizations and individuals. For example, the Google Co-op Health Section lists contributors such as the Centers for Disease Control, the National Library of Medicine, and the Cleveland Clinic. When searching for various health topics, the "labels" from these contributors are included as part of the search under the "Refine results" section. Searching for "kidney stones" on Google, for example, displays the following additional links:
Clicking "From medical authorities" provides only links that have been labeled by the contributors as being from reputable medical authorities. This is one way of combining the expertise of health care organizations with the results from Google's search engine.
In part 4, I'll conclude with a look at searching for more detailed health information using Google Scholar and PubMed.
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