Oct 27

Web 2.0 in Physical Therapy: A Practical Overview

Eugene Barsky and Dean Giustini wrote an editorial for Physiotherapy Canada on practical tips and useful Web sites for physical therapy that is short, practical, and chock full of resources I know and like. It isn’t comprehensive by any means (and doesn’t seek to be), but I think it provides a really good, digestible introduction to some useful tools for those in physical therapy.

Barsky E., & Giustini D. Web 2.0 in Physical Therapy: A Practical Overview. Physiotherapy Canada, 2008; 60(3): 207-215.

Available at either of these URLs:
http://www.swetswise.com/eAccess/viewFulltext.do?articleID=38506191

http://utpjournals.metapress.com/content/j767550n62473718/?p=6d30aec4e9ba49ae905cefbbfa34e113&pi=0

Aug 27

The Health Blogosphere: What It Means for Policy Debates and Journalism

Interesting item via Patricia Anderson: A Kaiser Family Foundation panel on the health blogosphere.

Interesting to note that the only bloggers on the panel are from the U.S. Department of Health & Human Services and the Wall Street Journal. Where are the physician bloggers, patient bloggers, nursing bloggers, etc.?

Aug 15

Pam Dolan on Medpedia in American Medical News

Amidst all the coverage of Medpedia that has generally seemed to be derived from a press release is this more informative article from Pam Dolan at American Medical News.

I’m quoted in the article:

Medical librarian and blogger David Rothman, who regularly writes at DavidRothman.net about medical wikis, expressed concerns about the regular monitoring of Medpedia’s content. “If the academic institutions … wish to avoid embarrassment, I’d recommend that they dedicate some time of their health care experts to regular review of articles,” Rothman wrote.

He estimates about 65 medical wikis exist. He’s not sure what the involvement of prominent medical institutions will mean to the project, noting that comparisons won’t be possible until the site is up and running.

As I usually do when I’m interviewed or quoted, I thought I’d post the entirety of my comments here. Pam got my views partially from this post I wrote about Medpedia and partially from an email. Pam’s questions are bolded:

My question for you is whether or not medpedia will be the largest collaboration of its kind for a medical wiki…

That depends on what you mean by “largest” and what we learn about Medpedia when it comes out of Beta. We haven’t yet seen how many contributors/editors it has or how many articles/words it contains. We won’t know for months after it begins how active a community it has. What other metrics could be used to measure “largeness”? The names of affiliated institutions? Medpedia doesn’t really say exactly what contributions those institutions are making (aside from, apparently, allowing the use of their names and logos).

…and if it will raise the bar for those wanting to develop medical wikis in the future.

I think that remains to be seen. So far, Medpedia looks to the public like a press release and a mock-up. When it is up and running, we can begin to compare it to other efforts. Until then, such comparisons aren’t possible.

Aug 07

More Health Information Wikis

I’ve added a few new sites to the list of medical wikis.

No, I’m not going to add Medpedia to it because Medpedia is still in beta. I’m flabbergasted how much press it is getting while not even visible to the public. They must have hired the right PR firm.

Wikis recently added to the list are noted below (details are in the list itself):

Aug 01

Notes on Medpedia’s changes

I first wrote about Medpedia in January.

I noted in my post that Medpedia did not seem to specify what would qualify an applicant to become a contributor. Medpedia’s Angela Simmons addressed this in the comments:

Anyone with medical and health knowledge is encouraged to apply to become a Contributor. It is not a requirement that you have medical credentials; however, it is important that you are passionate and knowledgeable about at least one topic related to medicine, health and the body.

My concern here is that clinicians should not use an information resource built by people who are not qualified health professionals. Passion is not, in my view, a sufficient qualification.

I also asked Angela if Medpedia was intended to be a resource for professionals (like UpToDate) or a resource for healthcare consumers (like MedlinePlus). Angela replied:

Initially, Medpedia will be a resource for the general public. Over time, with 1000’s of clinicians and researchers on the site, discussing what should be on the main pages, Medpedia will also become a resource for medical professionals, health educators, and medical schools.

This did not seem promising to me. I don’t believe that a single article on a topic can appropriately serve both healthcare professionals and healthcare consumers- their needs are usually quite different.

Medpedia seems to have addressed some of these concerns since that time. Their index page now only invites “Medical Professionals” to “Apply to be a Member, ” and the FAQ says:

There are multiple ways of contributing. If you are an MD or PhD in the biomedical field, you can apply to become an Editor and make changes directly to Medpedia articles (See more below). If you are anyone else, you can use the “Make a suggestion” link at the top of any page to make a suggestion for that page. An approved Editor will review and potentially add your suggestion.

Also interesting to note that Medpedia will be advertising-supported (neither Ganfyd nor AskDrWiki are ad-supported. AskDrWiki is a non-profit). Again from the FAQ:

To support the costs of operation in the future, non-invasive, text-based advertising will be shown on the Medpedia website through third-party ad networks such as Google’s AdSense or Healthline’s third party ad service. Next to these ads on the page will be a link “Flag inappropriate ads” so that the community can keep the ads on the site clean and useful.

Then there’s the question of how reliable the content will be. The FAQ says:

The seed content available on Medpedia at launch is up to date, accurate, and provided by reputable sources. After launch at the end of 2008, once Editors start making edits and adding new pages to the seed content, it is possible, and even likely that there will be mistakes and language that is unclear. This is the nature of a collaborative wiki.

If the site is meant to be used by healthcare professionals, I’d strongly recommend a routine (Monthy? Quarterly?) review of each article by an admin to make sure the content is accurate and up-to-date. To say “it can’t be kept reliable because it is a wiki” is, in my thinking, a cop-out. After all, Medpedia’s own FAQ says the site is meant to be “…a platform to share the most up-to-date medical knowledge.” If the academic institutions listed on the front page of Medpedia wish to avoid embarrassment, I’d reccommend that they dedicate some time of their healthcare experts to regular review of articles.

Prediction:
(Just a guess, but) I think Medpedia’s content will end up focusing mostly on the information needs of healthcare consumers. In that sense, I think it’ll resemble MayoClinic.com

Criticism aside, here are some things about Medpedia that I DO like:

  • Editors/contributors must be qualified health professionals
  • Editors/contributors cannot be anonymous
  • Content is freely usable under a GNU Free Documentation License

What do you think? Do you anticipate other problems I may have missed? Maybe you think I’m being too critical? Share your thoughts in the comments.

Aug 01

A Thought on the Online Rating of Doctors

When discussing sites which allow patients to rate doctors, I have frequently heard the argument that the ratings wouldn’t really be useful or meaningful.

My response to this is that it doesn’t matter at all how accurate or meaningful the ratings on these sites are- users will like them (and use them) regardless.

My wife, for instance, spent a good bit of time examining books about pregnancy, parturition, and the care of infants. Rather than making use of the abundance of experts at her disposal (including midwives, OBs, medical librarians, and pediatricians), she took very seriously how well reviewed and rated each book was on Amazon.com.

Nevermind if the particular review of a particular book showed the reviewer to be ignorant and semi-literate. What mattered was that the ratings were overwhelmingly positive.

So here’s the advice I gave physicians at the 28th Annual AMA Medical Communications Conference:

Rather than fretting about potentially negative reviews on sites that allow patients to rate or review physicians (about which, after all, little can be done), the physician should place her/his efforts into building a very strong Web presence. Hire a white hat SEO consultant if you have to, but make sure that anyone Googling your name (or your practice’s name) sees YOUR site first in the search results.

Jul 29

Online Social Networks in Healthcare & Libraries (slides)

Another great overview from Patricia Anderson:

Above: Those reading via RSS aggregator may need to visit the site to view the embedded slideshow.

Posts from this blog about online social networks

Jul 21

Physician Rating Sites (Guest post by PilgrimTinker)

The following is a guest post written by PilgrimTinker (a pseudonym for a consumer health information librarian who regularly blogs at Learn to Live.
___________________________

So, you need to see a doctor. Or, you have been seeing a doctor for some time and love her, or can’t stand her, or secretly suspect him of not paying appropriate attention to your complaints or wonder if he knows anything about geriatrics. Whatever the initial question, you decide to google him. And you discover that there are dozens of physician rating websites available, ready to help you dig up dirt or make a choice or trash a reputation.

Have you guessed yet that I am feeling ambivalent about these sites? I am. On one hand, it makes perfect sense to be able to research a physician or facility before you choose them for your health care. It’s responsible health care consumerism. On the other hand, doctors aren’t used cars and the complexity of medicine and the nature of the relationship between a patient and a physician cannot be portrayed with a simple matrix.

With these considerations aside, another difficulty in assessing physician rating websites is the large number and variety of choices. Here I offer a sampling, by no means exhaustive but more of a snapshot. I’ve looked at many more and chosen these as fairly representative.

First, there are physician directories, offered by government sources or various medical associations. These will verify an affiliation or specialty, board certifications, and contact information. They don’t offer much or anything in the way of user satisfaction but will verify professional credentials and provide a list of practitioners in a geographic area or at a particular facility. For a good start finding this kind of directory, try MedlinePlus GoLocal, the US Dept of Health and Human Service’s HospitalCompare or the AMA’s DoctorFinder.

Now for that more problematic category, the sites that encourage patients to publish their opinions and experiences and to surf what others have already posted. Let’s take a look at a few.

RateMDs.com makes posting ratings very easy- no need to sign in or create an account. The comments are completely anonymous, though they are read by the moderators and may be removed or edited. This is a fairly common policy on physician rating sites. The site uses a smiley face system, based on 2 questions: Is the doctor helpful and Is the doctor knowledgeable.

The downfall of this simplicity is that the faces become meaningless; as demonstrated by the comments for an obstetrician I saw in another city long, long ago. Several can be summed up by “he save my life, we wouldn’t be here if not for him” while others amounted to “he doesn’t answer questions, I would never recommend him, he is uncaring”. The only way I can imagine a site like useful is if there were thousands of comments per physician before they were displayed and the questions were more skillfully stated, allowing the number of responses to create a trend.

DrScore.com is also easy to use and invited me to rank my doctor on a scale of 0 to 10, with an option to post up to 40 words worth of commentary. They encourage raters to note “particularly good things you noticed about the visit” and that “Ratings and comments submitted to DrScore are designed to give feedback to physicians to help them enhance their medical practice.” This is a different and much more positive twist on the usual protect-yourself-by-digging-up-the-dirt approach to promoting physician rating venues. The process included more questions rated 0 to 10 such as time spent with the doctor, if and how well the doctor answered questions, treatment options offered, treatment success and ease of communication with the entire practice. The search works best for those checking ratings of an individual so it took several tries to get a list of physicians in one city to browse by score. The scores are divided into category and displayed on a 0-10 scale, providing a more nuanced profile than RateMD.com’s smilies.

Vitals also allows for consumer ratings of physicians but gathers information from medical boards, federal websites, hospitals, doctors, surveys, business alliances and third party affiliates. I found this search interface to be the easiest to use and the results display very slick. There are several interactive features that actually work, such as a compare box that displays choices side by side and an alert feature for changes to a profile.

Results are divided into sections including specialty, hospital affiliation, education and publications, with links and mapping features.

The rating feature asked only 7 questions with a final overall assessment; asking patients to respond from disagree strongly to agree strongly. This leads to the same limitations as the other sites data, but there are several reasons I like this site better. One is the 360 vitals view, diagrammed on the about us page. It is divided into thirds for empirical information, consumer ratings and peer reviews. The site encourages consumers to think more broadly about what makes a good physician. The search interface and results were much better than any others I’ve seen. Every feature I tried worked as I had hoped, never asking me to sign in, pay for a report or requiring me to use a series of those annoying drop down choice boxes.

But seriously, what about that elusive quality, hotness? Yes, there is a website for that particular aspect of a physician’s fitness to practice and I found it, thanks to an ad on WebMD. PharmaStats promises plenty, including a special icon to alert us when a hot physician has been identified. Unfortunately, the site didn’t deliver- results only included the most basic yellow pages contact information and the chance to “register for more results”

While we are on the subject of unfair or irresponsible ratings, I can’t quite classify The Healthcare Scoop.com. At first, I thought maybe I wasn’t on the home page but found that yes, it is simply a list of random posts with no format at all. Or, as they describe it, “Real, straight-forward information – written and shared by people just like you – about personal healthcare experiences.” Patients simply create an account and post a story, which is then immediately posted. The site also includes ads and a few search features (by doctor, by facility) but doesn’t organize the collected information in any other way.

There are several websites that charge fees for reports about individual physicians, including Angie’s List and HealthGrades, which wanted me to buy a report to see Disciplinary action, board certification, phone numbers and much more! These seem to be the least useful and most likely to prey on those easily frightened by contorted statistics in headlines.

What exactly do you need to know to intelligently choose a doctor? Their clinical proficiency? Quality of their office service? Bedside manner? Personal experiences and biases? What they learned from their first surgery experience and how they responded to their first death? How many journals they read and if they know about the latest advances in medical genomics? What about if they are willing to prescribe antibiotics over the phone for your niece? Will any of these sites allow you to determine if your physician is well educated, experienced and open minded, willing to listen and think and to use her hands to keep you as healthy as possible for as long as possible?

Surf all day if you like, but I’ll have to default to what is emerging as my personal take on the whole health 2.0 movement- thanks, it is nice and I’m glad to partake but there is nothing like the human touch. Give me my blink moment, when that young pup/pretty face/tanned golfer reveals with an indefinable gesture or prescient connection that they have heard me, and even better, that they have a plan for me. Medicine is practiced face to face, so ultimately, it is the face to face assessment that will convince me of a physician’s worth.

____________

Interested in writing a guest post while David is on paternity leave? Send your submission to:

Jun 03

Three Suggestions for the MLA: Inexpensive Web Projects

At the AMA’s Medical Communications Conference, I insisted to a communications professional from a state professional association that professional associations needed to take advantage of social Web technologies and utilize them to the benefit of their members.

When pressed to explain WHY professional associations should do this, I said that those professional associations who don’t adopt these technologies will find that their members (and potential members) will use these technologies (without assistance from their professional associations) to organize without organizationsI haven’t read this book yet, but I love the title and urge you to please send me a copy.. Where will the professional associations be left when that happens?

With that in mind, here are some projects I’d love to see the MLA pursue.

1. Stop publishing books on dead trees

As I understand it, books published by the MLA are generally written by uncompensated MLA members, edited by uncompensated MLA members, and selected for publication by a committee of uncompensated MLA members. The selling of these books does not raise much (if any) money for the MLA.

Since this book publishing makes no money and the MLA members are okay with donating their time, why not post the book content online in the members-only section of MLAnet and make access to them a benefit of membership? The cost of providing this content would be reduced for the MLA and the content itself would become available to (and searchable by) all members of the MLA, regardless of their institutions’ book budgets. If any members just HAVE to have an MLA book on paper, MLA can make them available for order via Lulu, shifting the cost of print copies exclusively to the reader.

2. Make an “open source” resource to compete with Doody’s Core Titles

Alan Fricker was the first person who put this idea in my head.

Know who writes reviews for Doody’s without compensation? Largely MLA members.

Know who makes the decision to include access to DCT in their budgets? MLA members.

Why couldn’t the MLA offer a platform that accomplishes the same thing as DCT and invite all of the Doody reviewers to instead review for the MLA? The argument for both librarians and other clinical professionals would be that, if the resource is made available to all MLA members as a benefit of membership, everyone’s libraries can be better-informed and reallocate the money that used to be spent on DCT towards other needs.

Perhaps a (free) Pligg installation in the members-only section of MLAnet would do the trick?

3. Create a hedges and filters wiki

A handful of people I know have spent a good bit of time trying to convince me that librarians sometimes actually prefer to hoard their expertise and would be unwilling to share the hedges and filters they’ve spent time developing and perfecting. I prefer to hope that hoarding is on its way out and that the better model of unrestrained sharing will completely supplant it. With copy-and-paste ease, it’d be a pretty easy kind of wiki for librarians to contribute to- and the usefulness to working librarians (and to those who train new librarians) would be enormous.

Your turn!

These are just three ideas. Are they bad ideas? What else would be a good Web project for the MLA to take on? Let me know in the comments?

May 26

MLA 2008: Plenary Session IV Slides

David Rothman

Amanda Etches-Johnson

Melissa Rethlefsen

Bart Ragon

May 26

New GroupTweet for Medical Libraryfolk

Well, I think the MLA2008 GroupTweet I set up can be called a success. Patricia Anderson did an analysis of its use during the Plenary IV Session that makes very interesting reading.

Many who used the MLA2008 GroupTweet during the conference said that they might like something similar year-round, so I set up a GroupTweet for medical libraryfolk to follow at http://twitter.com/medlibs

After you follow the account and it reciprocates, you’ll be able to send tweets to everyone who follows it by tweeting D medlibs [message here].

May 17

MLA 2008 – My Schedule

Reading this from T. Scott’s blog made me feel a lot better:

“We feel like this every year,” I tell Lynn. “In the last couple of days before the MLA meeting we’re completely stressed out and we don’t think there’s any way that we can get everything done that needs doing. But we always end up having a great time…”

Thanks, Scott- I needed that.

Here are the three times I’ll be speaking:

  • Web 2.0 for Professional and Clinical Productivity (Co-presenting with Patricia F. Anderson)
    Session Title: Evidence Base: Web 2.0 for Professional and Clinical Productivity
    Session Type: Section Program
    Session Start: 5/20/2008 4:30:00 PM
    Session End: 5/20/2008 6:00:00 PM
    Location: Regency Ballroom A
    Description: The Lecture on the Evidence Base focuses on the evidence base underlying clinical practice including its content, organization and its use. This year’s proposal is to bring in one or two experts on the emerging Web 2.0 technology and how it is being applied in healthcare related educational and clinical settings to improve the productivity of professional and clinical staff. Librarians need to see how these emerging technologies can affect health care settings in the future to know how to train and supports students and staff who will be working in these settings in the future.
  • Session Title: Plenary Session IV: Web 2.0 Tools for Librarians: Description, Demonstration, Discussion and Debate
    I’m one of four presenters (others are Melissa Rethlefsen, Amanda Etches-Johnson, and Bart Ragon- all of whom kick butt)
    Session Start: 5/21/2008 9:00:00 AM
    Session End: 5/21/2008 12:00:00 PM
    Location: Grand Ballroom
    It’ll be Webcast(ed?) live.
  • Session Title: Not-So Dangerous Liaisons: Best Practices for Library Liaison Work (CE801)
    (Presenting with Michelle Kraft and Molly Knapp from 3:00 to 4:00)
    Session Type: Meeting Symposia
    Session Start: 5/21/2008 12:30:00 PM
    Session End: 5/21/2008 5:00:00 PM
    Location: Columbus ABCD
    Description: Many health sciences libraries have initiated or are planning liaison programs to help direct public services efforts more efficiently and with greater authority. As these liaison programs take form, valuable lessons are being learned about interacting effectively with academic departments. Communication, collaboration, and instruction all play a role in being an effective liaison. This symposium will address the various facets of liaison work among librarians, both academic and hospital-based, including methods for initiating or improving liaison programs, effective communication and instruction techniques, improved understanding of web 2.0 technologies as they apply to liaison work, and methods for evaluating the success of library liaison programs. Participants will have an opportunity to interact with panels composed of participants in successful liaison programs and to discuss how they might build a program at their own institution, utilizing some of the lessons from these panelists.

I’ve been working on a tentative schedule using Google Calendar, but I suspect that that some plans may suddenly change. That’s okay- change is good.

I won’t know a whole lot of people at MLA 2008, so please say hello if you go to any of these sessions! I’ll look pretty much like this, but with a more confused expression on my face. :)

May 15

Twittering at MLA 2008

There are a number of medical libraryfolk using Twitter, so I thought it might be fun if we were able to conveniently send each other short messages during MLA 2008. All I had to do was set up the MLA2008 account and register it with GroupTweet.

Here’s how you can join in:

1. Go to http://twitter.com/ and sign up for a free acount
2. Go to http://twitter.com/mla2008 and click “Follow.” Shortly thereafter, you’ll receive notifcation that the MLA2008 account is also following you.
3. When you want to send a message to ALL the medical libraryfolk who follow the MLA2008 Twitter account, type: D MLA2008 [Your message here].

The MLA2008 account will take this direct message and tweet it so all who are following MLA2008 receive it.

If you want, you can set up your mobile phone/device to receive tweets (silently or on vibrate when in a session, please- be polite and considerate) and use it to organize or gather information.

Nikki Dettmar today used it to let us know where there was good, free WiFi not far from the Hyatt:

Questions? Check Twitter’s documentation or leave questions in the comments below. :)

Apr 14

The AMA’s Medical Communications Conference

I think I may take the week off from blogging.

Until Tuesday afternoon, I need to get some writing projects done and make preparations to be away from work for the rest of the week.

I’m flying to San Diego Tuesday afternoon for the American Medical Association’s 28th Annual Medical Communications Conference. I’m excited about serving on this panel partially because I’m acquainted a little with Craig Stoltz and Jason Bhan.

Craig is a former health editor for the Washington Post, a former editorial director for Revolution Health, and a sharp guy I’ve enjoyed talking with. Last week, Craig’s Web 2.Oh…really? blog was recognized by TIME magazine as one its “Top 25″- and Craig (rightly) responded with an excellent critique of the feature in a post titled “In Which I Unwisely Bite the Hand That Feeds Me.

I’ve had the pleasure of a longish phone conversation with Dr. Jason Bhan, Chief Medical Officer of Ozmosis. We had intended to talk solely about Ozmosis, but we turned out to have a number of similar perspectives and I’m looking forward to chatting more with Dr. Bhan.

Some sessions I’m looking forward to attending:

So I probably won’t be blogging much this week…but reserve the right to change my mind.

If you’re going to be at the conference, please say hello!

Apr 11

“What the heck is Twitter and why should I care?” (Alan Cann)

Dr. Alan Cann made a very decent SlideCast to help explain Twitter (embedded below):

Patricia Anderson and Jill Hurst-Wahl convinced me to give Twitter a third try, and I’m glad they did.

Twitter is fun and I enjoy it, but wouldn’t enjoy it nearly as much if I wasn’t using Twhirl as a desktop client. If you try Twitter, here’s my advice:

1. Find the friends you want to try following and follow them.
2. Download and install Twhirl.
3. Leave Twhirl running in the background while you work. If you see a tweet that interests you or makes you want to respond, do. If the tweets you see don’t engage you, they’re easy to ignore after a quick glance.