Tim Berners-Lee, the inventor of the web, in his book Weaving the Web, claims that his original vision of the web was one of collaboration. He wanted people to participate in two-way sharing of information and decades after the web was born, web 2.0 is breathing life back into his original vision. Medicine has always been a consistently early adopter of technology and with the advent of web 2.0 and increasingly interactive and sophisticated tools, there is much discussion on the role of IT in medical education and also clinical practice.

A report out this month from Epocrates claims that 58% of US physicians go online for information at least twice a day (some moving beyond 5 times a day!) and 75% of survey respondents claimed they searched online for information more often now than a year ago. Most physicians (85%) go online during or between patient consultations with the rest accessing the web on breaks or before/after getting to the clinic. I think this raises some interesting questions around continuing professional education and knowledge expectations built unto medical education.

Interestingly enough, a new study out of the Vanderbilt University Medical Center reports that physicians who had trained in an IT-rich environment and who then go onto a facility with less technology felt unable to provide as safe and efficient care as they could have with IT. The report entitled “Performing without a Net” found out that 80% of Vanderbilt University graduates were in a facility with less IT than before graduation. While the study results support the greater adoption of health based IT and the need to have a formal system-wide education for everyone transitioning to a new system of care, they also underlined the need for this generation of physicians to be competent in both a highly developed IT structure as well as traditional processes and technologies currently experienced across a diverse set of clinical circumstances. Technology is a good thing, but so is tradition.

Take the palm pilot for example…..The Journal of Abnormal Psychology reports a new study claiming that hand held digital devices may be more effective in monitoring patient behavior than physician-patient interviews. What? I hear you exclaim! Well, if you have a patient with borderline personality disorder it seems that those little palm pilots are extremely good at monitoring mood variation among young adults. The palm pilot asks patients 5 times a day to rank their mood and it was this ‘in the moment’ response about how patients were feeling that proved to be more effective than the traditional “weekly check in meeting” where patients are relying on their memory to self report mood disturbances. Moreover, the data gathered and provided by this electronic diary allows providers to respond to their patients at any time and thus, the study concludes, help bridge a gap in physician-patient communication. Can anyone say hellohealth?

But what do you do, if you don’t have a palm pilot handy and you’re volunteering with Doctors without Borders in the DR of Congo with a 16 year old boy who needs his arm amputated or he will die? If you are British vascular surgeon David Nott and unused to the surgery necessary, you text your colleague back in the UK for step by step instructions on how to perform the operation. Caught with one pint of blood and an elementary operating theater, the operation, normally performed only 10 times a year in the UK and requiring an intensive care unit, was a success mainly because, as Dr Nott points out ” I knew exactly what my colleague meant because we have operated together many times.” Dr Nott adds,” I don’t think there are more than 2 or 3 surgeons in the UK who can do this; it was just luck that I was there and could.”

Technology and Tradition – two very important parts of what it means to be in clinical practice today and central to Clinic 2.0. Where there used to be a call “is there a doctor in the house?”, now that call is more global as we can see. In these interconnected times, that message goes out over little pieces of machinery driven by fingers across the globe in a split second. Clinic 2.0 is an incredible example of what we can do together and how that work is so much more powerful than what we can accomplish alone.

Giving thanks to  iPocrates, Paul Worthington for their talents!

Good things happen when we connect!

Kirsten Broadfoot

Tags: clinic 2.0, clinical practice, clinical practice guidelines, collaboration, continuing medical education, David Nott, Doctors without Borders, Epocrates, health 2.0, health IT, health web 2.0, hellohealth, Journal of Abnormal Psycholog, medecins sans frontieres, medical education, medicine, MSF, new technology, participation, physician-patient interviews, professional development, professional education, surgery, Tim Berners-Lee, Vanderbilt University Medical Center, web 2.0

This entry was posted on Monday, December 15th, 2008 at 12:14 pm and is filed under Blog.