Thursday, September 04, 2008

Medicine 2.0 Conference opening day

The first Medicine 2.0 conference has opened today in the MARS Centre, Toronto.

After a couple of days of sightseeing (the Niagra Falls trip was spectacular) we are finally getting down to business. This post is being written "on the fly" during the day so I apologise for any typos or other formatting errors.

Thanks should initially go to Gunther Eysenbach for the organisation. He is the Senior Scientist at the Centre for Global eHealth Innovation, Toronto and Editor/Publisher, Journal of Medical Internet Research (JMIR)

The venue seems well setup with easy access to the wireless network & good coffee. It is quite interesting to meet many people face to face which I have only previously met online.

Peter opened the conference on behalf of IMIA & other hats who thanked Gunther & talked about what IMIA is, in particular the IMIA Web 2.0 Task force and CHIRAD. He looked forward to the programme with presenters from over 15 countries & the conference teams use of Web2.0 including Crowdvine &the online paper rating system.

Gunther described how he tested the Canadian healthcare system by breaking his wrist & instantly changing his status on Facebook. More seriously he used his experience to talk about the potential of getting access to his medical record & have some connectivity with the healthcare system & making contact with peers who had similar injuries. He gave a high level overview of some of the relevant systems focusing on the interaction between evidence based medicine & personal health information - and the bypassing of the gatekeeper. I'm still not sure his definition of Apomediation via collaborative filtering approaches will become reality this week - but it is certainly one of the directions we may be moving in. The idea behind a Personal Health Record 2.0 has potential for the consent to store or consent to view debates we have been having in the UK. He highlighted some questions which he challenged the attendees to address during the conference & asked what are the specific requirements in healthcare. He hoped we would provide a critical view and not blindly follow the needs of the venture capitalists. He gave the housekeeping notices and thanked the sponsors.

The first keynote speaker was Pat rich - the Director, CMA Online Content. He spoke about Asklepios & what they are trying to achieve with it. He started with an overview of the CMA & talked about their movement into online resources including and chronic disease tracking shared by patients and Doctors. He explained the rational for setting up the social networking site - many of them already blogging, posting videos etc - based on US data & then dividing the numbers by 10. He talked about the value of informal discussion - based on the doctors lounge idea - coming from surveys of their members. The rationale for a secure physicians only site was presented. The need to avoid US hosting & lay grounds rules rather than moderation eg politely criticising the president was seen as important. The initial pilot was on Ning & then opened up to 125 physicians in the pilot. They then worked with a web services company and launched it a couple of weeks ago and already have 150 members. He described how people are setting up groups on it for discussions of a range of topics. He talked about the plans for the future and monitoring systems. He finished with the unanswered questions they are still trying to find out with the site and highlighted the need for evaluative research. Questions touched on the economic model behind it and the profile of users, which included "sponsored areas",and the possibility for guest access for colleagues from other countries. A good questions raised the potential for "unintended consequences".

The second keynote was by Michael Massagli from patientslikeme based on comments from the sites users, particularly those in the amyotrophic lateral sclerosis (ALS) group. He described the site and how it is used by those with particular conditions to find others who have similar experiences. The graphical representation of structured and unstructured data and the potential for discussion through forums, private messages etc. The analysis of the user generated massages showed a "hard core" of people who greet new members & others where specific phrases indicated users were basing their comments on the posted profiles & how comments fitted into wider patterns. Much of the analysis is in his paper Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community: What Can Happen When Patients Have Access to One Another’s Data so used his presentation time to show what the dialogues were like. The latest work has examined whether patients can answers clinical questions as a group - based on having read a journal paper about lithium use for ALS - this led to new tools to track individuals experience with the use of particular drug regimens. His work has concluded that patients do look at and comment on each others data - and can potentially generate new data centered user conversations that are useful.

After coffee (which included an interesting discussion on an open access business model for videos from the Journal of visualized experiments) the conference split into several themes. I attended a sessions on blogs. Neil Seeman opened with a discussion of how opinion leaders and how those who make decisions in healthcare systems are influenced. He suggested that opinion leaders may not enjoy status as they did in the past. Social networking analysis has been used to analyse health topics on popular sites such as myspace and facebook. The groups which are most active are those about conditions which are most stigmatised. The number of contacts may not be the indicator but the level of use but more important is trust. The ideas are linked to personal empowerment in dealing with healthcare providers. Amongst practitioners the knowledge management features of a blog were the things which made them go back to the blog. The growth of the blogosphere is a factor in breaking news and can not be ignored by the traditional media. He also talked about blog governance scores and other factors which affect blog density. Both blogs & newspapers were not reporting clinically significant health stories - but the ability to engage with the audience is significant. General interest blogs do as well as newspapers. There is an inverse link between governance score and traffic. An interesting thought was that SME = Subject Medical Expetise rather than Small or Medium Enterprise - which would be more common in the UK. Questions linked to future directions and advertising/sponsorship or conflicts of interest. Companies which pay bloggers to post on particular topics need further analysis.

This presentation was followed by a bloggers panel. Organised by Bertelan Mesko who introduced speakers giving short presentations - the first was Jennifer McCabe looking at business blogging via a Ning group ho discussed Web2.0 tools for medical students. She highlighted cross-pollination as a way of patient (consumer) centered care & innovation in healthcare practice & management. She gave a range of recommendation for anyone wanting to be a healthcare blogger. Peter Murray went next talking about collaborative blogging for health informatics based on the work of the team. He blamed me for starting it all back in 1996 and gave an overview of the developments we have undertaken since. He summarised the lessons learnt and ideas for the future. Keith Kaplan was the next participant talking on digital pathology and the lessons and reflections from writing his own blog and academic blogging in general in particular within a centre such as the Mayo clinic. The next speaker was Sam Solaman a reporter and saleried bogger. He told the story, which he wrote up for the Canadin Medicine journal, of a doctor Robert Lindeman who was sued and wrote uncomplimentary comments on a blog under the name flea and draw lessons related to the risks of anonymous blogging. See the Personal Injury Law Blog and the Boston Globe for more details of the story. The final speaker of the panel was Bertelan Mesko a medical student who described his use the web for his studies. He is now running learning experiences with community sites and blog carnivals. He is now running which provides cross searching facilities, and a range of other online tools. He closed with a plug for

A list of all the others twittering or live blogging from the conference is at

After a quick lunch (because the morning sessions overran) I attended the education theme. The first presentation was by Leanne Bowler who has a background in information design and is now looking at health sites for teenagers. Not surprisingly they use the web for health information, but their skills in finding & evaluating the information is poor. She defined portals and digital libraries and was looking for what exists & what are they like. She conducted an environmental scan and tied to measure usability, findability etc. She presented various issues with many of the sites which were included. Good question and answer session which highlighted several issues about web site design and information seeking behaviours.

The next presentation was by Margaret Hansen about Versatile, Creative and Dynamic Virtual 3-D Healthcare Learning Environments. She defined Web2.0 & Web 3.0 and looked at their potential within education for healthcare professionals. She explained many of the issues identified in her recent paper in JMIR. She showed screen shots of Second Life and other virtual worlds to illustrate pedagogical potential, based on connectivism, for role play to reduce anxiety, enhanced competency and collaboration. ALIVE was advocated as providing an easy to use environment for elearning. Technical issues limited the access to a YouTube video of the sexual health simulation from second life from Maged in Plymouth. Margaret then outlined some theoretical frameworks from Rogers Diffusion of Innovations, Siemens Connectivism. She highlighted some of the challenges and concluded that we will be seeing the growth of 3-D in educational contexts.

The final session of the day for me was entitled Web 2.0-based medical education and learning, chaired by Chris Paton. The first speaker was Panos Bamidis from Greece speaking about the use of Web 2.0 technologies in Medical Informatics education focusing on sharing learning objects. He described how ICT supported the whole educational process from planing, delivery and evaluation. He talked about international standards SCORM etc and then how discussion forums, wikis and personal blogs, within a closed Moodle VLE, are being used to support the learning. He presented the results of an evaluation which showed positive attitudes from students who had experienced the technologies, and plans for the future.

The second presentation was by Deidre Bonnycastle from the University of Saskatchewan talking about Medicine 2.0 and Medical Faculty Development. She had found the technology had barrier and the cost of professional production was prohibitive. A second approach was to use a post workshop wiki and set up a medical education blog. A development was to create a committee wiki, and research group wikis and student wikis. She then developed a Distributed medical education site and her latest development is a Medical Education Wiki. They include RSS feeds from blogs. Another area is the use of Elluminate real time lectures with audio, interactive whiteboards etc. A question arose around the time required to keep up with social networking sites, and human filtering via fiendfeed type technologies.

This was followed by Bertalan Mesko (Berty) talking about medical education and building a reputation in a Web 2.0 environment. Inspiration and motivation were received from online environments, particularly second life, such as the Anne Myers Medical Centre for virtual case presentations, genomics exercises and other areas. He also talked about a range of other online environments, including the recently launched Medical Education Evolution on Ning. He then talked about the benefits and risks of an online reputation. He showed examples of good practice of onlie doctors, blogs community sites etc. He suggested everyone google their name to see what patients or clients will see. He concluded that we must be ready to be open and ready to build an online reputation.

The final presentation was mine.

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  • Rod, thanks for the post. Enjoy reading and seeing the conference in this fashion. Much prefer in-person but $'s and new job win out this year. The terms you posted about as elucidated by Gunther I need to read more about (apomediation? and I can't recall the other). Anyway, thanks!

    By Blogger Scott, at 3:41 pm  

  • > I need to read more about apomediation?

    Hi Scott

    I looked it up- it's just disintermediation.


    By Blogger Derek Hoy, at 3:48 pm  

  • Thanks, Derek.

    By Blogger Scott, at 5:53 pm  

  • Peter blamed you, Rod?!? Ouch!

    By Blogger Scott, at 6:40 pm  

  • >Peter blamed you, Rod?!? Ouch!
    The comment was contextual - for 'fault', one should really read 'credit', as IMHO, it is due to the early work that Rod did on conference reports that we are ding all this conference blogging, as an evolution.

    By Blogger Peter, at 1:15 pm  

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