The premise of Health 2.0 rests on one simple idea: whatever your healthcare question or concern may be, there is a potential community of likeminded individuals out there who also have similar questions and are ready and willing to share information, opinions, and support. All you and your potential collaborators need are the tools that will allow you to connect with one another. So what qualifies as a Health 2.0 tool? Blogs, wikis, RSS feeds, social networks and online communities, bookmarking and other indexing services, and many more—the list is far-reaching and constantly expanding as smart people figure out new ways to organize and share information, communicate, and collaborate. 

We’ve compiled a list of 20 of the most useful, exciting, and intriguing Health 2.0 tools, some of which you may already be familiar with, while others may be new to you. Take a few minutes to visit some of these resources and see for yourself what all the excitement is about. E-mail us to share your thoughts and let us know if we missed any of your favorite Health 2.0 sites. 

 Physicians and other healthcare professionals can contribute to this “collective online memory” bank by publishing their review articles, clinical notes, pearls, medical images, and other information. Before new users are granted permission to post content, they must first submit their CV for verification; all credentialed users are added to the site’s editorial board. Submitted content is reviewed by specialty editors; after it has been accepted and published, it can be edited by the AskDrWiki community. 

Unabashed enthusiasm, unfailingly useful inks and information 

David Rothman, Information Services Specialist at the Community General Hospital Library, Syracuse NY, created this personal blog that discusses medical librarianship and Internet technology, or as he terms it, “Web Geekery.” He offers great 2.0 tools and tips for healthcare industry professionals. The blog features a custom Google search engine created by Rothman that searches medical school libraries, and another custom search engine that finds consumer health and patient education information. A list of medical wikis and medical illustration resources is equally helpful. A mobile edition of Rothman’s blog is available as well. 

 “Dueling Doctors” video discussion/argument groups 

 This excellent source of physician-created multimedia content features “short one- to two-minute streaming video clips designed to get to the point, with insights and opinions from experts in 35 different specialties, as well as community and lifestyle features that help doctors stay on top of the latest news, ideas and information.” 

“Natural language recognition” search capability 

 Patients can use this interesting tool to check for drug interactions and to match their symptoms with possible drug side effects. Information is retrieved by the site’s innovative search engine from a variety of medical textbooks and other reliable sources. The treatment evaluator function rates common treatments for a variety of conditions according to “general effectiveness, ease of use, side effects and safety.” The “User Reviews” enable members to share their experiences and insights about the medications they have used and the treatments they have received. 

 The Efficient MD is a physician-written blog focused on helping healthcare professionals increase their productivity and therefore maximize their time. Visitors will find how-tos, “life hacks,” advice and commentary, and reviews of useful new innovations, gadgets, techniques, and tools. Posts include “Using Evernote as a Professional Memory Accessible Anywhere,” “Tips for Medical Documentation and Coding,” “Google Book Search and Medical Education,” and “Your Next Stethoscope Should be Electronic. Here’s Why.” 

 Focus on empowering and engaging patients 

 Designed to continue the conversations begun by Tom Ferguson, MD—who “coined the term e-patients to describe individuals who are equipped, enabled, empowered and engaged in their health and health care decisions”&mdash;and his group of advisors, this site aims to help patients establish an equal partnership between themselves, you the provider, and the health systems that support both parties. This blog-style site features posts on an almost-daily basis, covering such topics as how we die, Internet diagnoses, personalized medicine, and the latest news from oncology and hematology conferences. 

 Health search engine and social network 

 Healia is an “independent, unbiased gateway to the highest quality health information resources.” Visitors will find a variety of valuable resources, including health guides on subjects from breast cancer to weight management, a blog that covers breaking health news, links to support groups, and much more. Visitors can also use the website’s powerful search engine to find specific information on health topics, and can limit their search results to content strictly from medical journals, clinical trials, or the Web in general. 

 Ridiculously well-informed contributors 

Written by some of the leading lights of the Health 2.0 movement, this community blog focuses on the latest trends and developing technologies in the healthcare world. Unique to the site is that anyone interested or involved in the Health 2.0 community may contribute to the blog. Recent postings include “MD Rating Sites: Current State of the Space and Future Prospects,” “An Impending Hanging: Will Health 2.0 Be Compromised by the Economic Downturn?” and “Microsoft Healthvault: Coke, Pepsi or Intel Inside.” 

Health Care for All aims to create a “consumer-centered health care system that provides comprehensive, affordable, accessible, culturally competent, high-quality care and consumer education for everyone.” The blog is updated daily and has an archive dating back to April 2005. Though many of the topics are based on the Massachusetts health system, the information is still useful and insightful regarding the latest developments on issues related to improving the quality of care provided to patients. 

Launched in 2008 by the NBC Digital Health Network, HealthVideo advances patient education by “providing its distribution partners with the robust content they need to create an informative viewing experience for the millions of users looking for health information wherever they may be.” The patient education videos and other content on the site are reviewed by experts and cover a wide range of medical topics.

Featuring biweekly blog posts written by 

 columnist Fard Johnmar, HealthcareVox offers insights into the ways in which social networking impacts the world of healthcare and technology. Johnmar also examines the impact of current events, particularly the transition to a new presidential administration, on healthcare and technology. 

Health search engine and information aggregator 

Intense focus on the consumer health experience 

Healthline offers “the easiest way for consumers to quickly and easily find consistently excellent health information on the Web” by providing a “robust search and navigation platform.” Useful resources on this site include “Medically Speaking,” an icon that automatically translates consumer terms to their medical equivalent; HealthMaps and other navigational and research aids; as well as more standard tools such as BMI calculators, symptom searches, medical dictionaries, health videos, drug profiles, and articles by health experts. 

Interactive drug database and patient community 

 Patients can use iGuard to screen for possible drug—drug interactions among the entire range of medicine they may be taking (including prescription drugs, over-the-counter drugs, nutritional supplements, and herbal extracts). Also, when new study results or other safety information are released, iGuard e-mails an alert to the patient (with the option of also notifying the treating physician), along with a pharmacist-written explanation of the potential implications of this new information.

Created with the idea that “you can make better health decisions using information and support gained by discussing your health experiences with others,” this free community site helps members find and share information and experiences on medical conditions, symptoms, treatments, and more with millions of other patients from across the globe. Finding answers and information can be performed in four ways: 1) posting a question that is distributed to thousands of members; 2) browsing hundreds of communities to find the one that is relevant; 3) browsing through members’ profiles by health interest, gender, age, or location to find the right connection and chat live with that person if they’re online or send them an e-mail from an iMedix e-mail account; or 4) searching for health articles using “one of the best health search engines on the Web that screen out the garbage for you.”

Interactive health directory and database 

MedicineNet has all the bells and whistles of a Health 2.0 website, including RSS feeds. An RSS feed (stands for Really Simple Syndication) allows users to subscribe to a website so that they can be notified when fresh content has been posted. For example, you can direct your patients with high blood pressure to this site and have them scroll down on the page to find the “High Blood Pressure” RSS feed, where they can download the button that will appear on their Web browser each time they open up the program. When they click the button they’ll see a drop-down menu of the latest content on MedicineNet related to blood pressure, and can be kept up to date with all the pertinent information. 

According to OrganizedWisdom CMO Howard Krein, MD, PhD, “OrganizedWisdom helps people do health research with our hand-crafted WisdomCards—full of expert-selected online resources&mdash;on thousands of popular search terms.” The word “organized” is certainly fitting for the site; for example, a patient looking for information on acne can enter the Acne Health Center, narrow their search by choosing “How To,” and further narrow the search by choosing “How to Avoid Acne.” Making that choice provides a page of referenced research notes, links to top resources found online, and user-recommended links. Users who want to share a resource with others can register (for free) to add their recommendation to a given WisdomCard. 

Podcasts allow users to download presentations, speeches, and explanations about medical procedures, clinical trials, and other topics. This convenient method of learning has gained in popularity over the past few years, as evidenced by the numerous websites dedicated to providing medical-related information. The 

 has a site with more than 500 medical podcasts, sorted by specialty; 

 offers more of the same, in addition to advice on practice-related issues; and the 

 is another excellent resource for medical podcasts. 

Patients, friends and family members, and healthcare professionals who are affected by rare disorders can benefit from this social hub, created in early 2008 to help change the “lack of information and support for patients and their families” that comes as a result of the “comparably low level of occurrences of individual rare disorders.” A brief, free registration affords members the ability to connect with others who are affected by the same disorder, share experiences and news in a particular disorder community, and discover resources that are specific to that disorder. 

 The active theme-and-subject-focused patient groups 

This vibrant global community of patients with diabetes uses a variety of tools to encourage communication and interaction. Members can post videos and pictures, post a blog on just about any diabetes-related subject, take part in lively discussion forums and chats, and join groups organized by geographic region or common interest to communicate with likeminded members. 

This site—which plans to add more specialties and locations soon&mdash;enables patients to make primary care, dermatology, ophthalmologist, ENT, orthopedist, OB/GYN, and dentist appointments in the New York, New Jersey, and Chicago metropolitan areas, for free. Site users can find doctors or dentists in their area, judge quality based on patient reviews and ratings, filter those who are left by insurance, and book the doctor of choice online any time. Physicians who want to add their practice to the directory can easily do so by filling out a quick form and submitting it online. Patients for whom ZocDoc doesn’t have listings in their area can enter their e-mail address and zip code to be notified when service becomes available. 

There are many definitions of Health 2.0, with most focusing on new technologies, openness, collaboration, and user-generated content sharing among physicians, patients, and other healthcare stakeholders. For now, we like Matthew Holt’s definition best: Health 2.0 incorporates “1) Personalized search that looks into the long tail, but cares about the user experience; 2) Communities that capture the accumulated knowledge of patients and caregivers; and clinicians and explain it to the world; 3) Intelligent tools for content delivery and transactions; and 4) Better integration of data with content. All with the result of patients increasingly guiding their own care.” 

Articles

The premise of Health 2.0 rests on one simple idea: whatever your healthcare question or concern may be, there is a potential community of likeminded individuals out there who are ready and willing to share.

20 Best Health 2.0 Tools for Physicians and Patients

In the past 12 months, we have seen the rise of social networking sites for physicians, growing enthusiasm for the concept of patient-centered medical homes, the roll-out of PHRs by major players like Google and Microsoft, a shift from medical search engines to general search engines, and the first wave of retail DNA tests. One thing we didn’t see in 2008 was major progress in physicians’ adoption of HIT. We tackle these topics and more in this review of some of the top health IT stories from 2008.   

Despite a number of efforts to promote HIT adoption, including studies showing the cost-savings that could accompany widespread HIT adoption; local efforts, such as 

Michael Bloomberg’s charitable foundation

 that provided $27 million for EHR adoption; continuous 

 to increase transparency and adoption; and financial incentives offered by Medicare for e-prescribing, the fact is that IT adoption in healthcare is proceeding at a snail’s pace. Let’s review some lowlights from 2008: 

 from the California HealthCare Foundation said efforts to create a Nationwide Health Information Network are “impractical and cannot be implemented,” and added that “none of the [health IT] leaders interviewed for this report could point to substantial, real advances in the adoption and utilization of [health IT] since the president launched his initiative.” 

 reported using a “functional EHR;” only 14% used a “minimally functional EHR.” Adoption rates were 35% in practices of 10 or more and 6% for solo practices. 

 that 90% of US physicians and more than two-thirds of hospitals still use paper records, putting healthcare in the country “at least a generation behind the rest of society in terms of technology,” according to David Merritt, project director at the Center for Health Transformation. 

 found that it will take more than 30 years at the current HIT adoption rate to expand clinical support tools to all US physicians. 

 found that although 68% of US hospitals have implemented some type of EHR, most are only used in parts of the facility. 

: According to a Healthcare Information and Management Systems Society 

, roughly 30% of physician group practice administrators said they have functional components of an EHR in place in their organization, up just 4% from 2006. 

 presented at the American Health Information Community meeting showed that between 2% and 12% of US hospitals use EHRs, depending on how the term is defined. 

It is becoming increasingly difficult to stump medical students on clinical rounds nowadays; they always seem to come up with the correct diagnosis, in part because they are particularly adept at finding the right information as quickly as possible using the Internet. 

Search engines are extremely useful, because they can take a query, find the words that match, and put them together into an outcome that makes sense. Unlike medical search engines that rely on keywords, from the author and the researcher, the Internet looks at all of the words entered and makes no judgments as to their value. Your words are just as important as the authors’, though there is some contextual awareness. 

Google makes no judgments unless you misspell a word, and it will then suggest a correction. It allows you to search the way you think, not how the author was thinking. Occasionally, you will type in a query, find the article, and get blocked because the publisher wants you to pay to view the content. To solve this problem, simply take the article citation and search through secondary sources at a university, hospital, or office library to do the PubMed or Ovid search. 

I am preparing to take my recertification in geriatrics, and during the individual self-evaluation medical knowledge modules, Google and Google Scholar were my best friends. When there was a question I needed help with, these search engines gave me the easiest way to find the right answer. If a keyword is obvious, and you search Ovid, PubMed, or Up-To- Date, you might narrow your query but still might be unable to find the quote. With Google, you type in the quote, and the article pops right up. 

—By MDNG editorial board member Eric G. Tangalos, MD 

The patient-centered medical home concept continues to gain steam as more and more physicians and organizations— including the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, and American Osteopathic Association&mdash;endorse the idea. In fact, these organizations have collaborated to produce the 

Joint Principles of the Patient Centered Medical Home

. Other organizations are now emerging to do their part to encourage the evolution of the medical home, including Bridges to Excellence, a not-for-profit organization that rewards healthcare providers who “demonstrate that they have implemented comprehensive solutions,” which has developed different levels of medical home designations. Physicians who are able to attain these designations can receive an annual bonus payment of $125 for each patient covered by a participating employer, with a suggested maximum yearly incentive of $100,000. To read more about the program, visit [

]. As support grows for this patient-centered approach to providing comprehensive primary care, the big question becomes, “What role will healthcare IT play?” Technology systems are already in place to help healthcare providers maintain records, electronically prescribe medications, and exchange all types of medical information. In order for the medical home concept to thrive, physicians will have to use information technology for care management and quality improvement, as well as to provide an adequate payment method and to communicate with patients. As is the case with many ideas intended to improve healthcare delivery, the technology is there, but the major stakeholders need to iron out interoperability issues, manage costs, and continue to produce standards that will truly make the medical home revolutionary.  

“In spite of continued talk about expanding health information technology, I am not aware of much tangible delivery.” —G. Stephen Nace, MD, MDNG editorial board member, and Associate Professor of Clinical Medicine, University of Illinois College of Medicine at Peoria  

Creating a single network for processing almost all US electronic prescriptions promises many benefits, including lower costs for providers and patients and an expedited and simplified medication ordering and dispensing process.  

Uncle Sam Wants You… to Get Paid for E-prescribing! 

 “a new initiative for physicians to trade in their prescription pads and improve efficiency and safety when ordering drugs for patients with Medicare.” The final step in a years-long legislative and policy effort, this announcement finally put into place a concrete (albeit modest) financial incentive for physicians who treat Medicare patients to take the leap into the brave new world of electronic prescribing. In addition to the well-known potential benefits for patients from e-prescribing (virtual elimination of drug errors due to illegible or misread handwritten prescriptions, reduced out-of- pocket costs, etc), now physicians, too, can derive tangible benefits. Physicians who adopt e-prescribing technology in 2009 and 2010 will get a 2% bonus in their Medicare payments. In 2011 and 2012, they will get a 1% bonus. Docs who wait until 2013 will get only a 0.5% bonus. However, starting in 2012, 

 will also assess a 1% penalty on physicians who refuse to adopt e-prescribing; the payment cuts will escalate to 1.5% in 2013 and 2% in 2014 (). 

If the combination of fewer medication errors and a little bump in reimbursement is appealing, but you are still unsure of how exactly you should go about trading in your trusty prescription pad, download 

The Clinician’s Guide to Electronic Prescribing

. Issued by The eHealth Initiative in collaboration with the AMA, the AAFP, the ACP, the MGMA, and the Center for Improving Medication Management, the guide was created to be a “how-to” guide to “help clinicians make informed decisions about how and when to transition from paper to electronic prescribing systems.” For more on the various caveats, adjustments, and concerns some practitioners have raised, read Dr. Robert Jasmer’s detailed 

“In the single most significant advance to the accuracy, efficiency and quality of information associated with the four billion prescriptions written annually in the United States, the nation’s retail pharmacies and leading pharmacy benefit managers (PBMs) today announced an unprecedented collaboration to unite the country’s two leading health information networks.” Thus was the merger of SureScripts and RxHub announced with typical understated corporate PR-speak. Seriously, though, this was a major development. Creating a single network for processing almost all US electronic prescriptions promises many benefits, including lower costs for providers and patients and an expedited and simplified medication ordering and dispensing process. Plus, the combined network’s sheer size and ubiquity enable it to set standards for the whole industry, which has its good and bad points (good in that it simplifies things for technology vendors, while also requiring them to create products with valuable features like medication histories and eligibility checks; bad in that there are always concerns whenever one player in an industry is in a position to wield so much infl uence; privacy advocates have also expressed worries about having so much patient data in the hands of one company). Go read more about the company and the details of the 

 Magazine Just Spittin’ in the Wind When it Comes to Personal Genomic Testing? 

magazine was spot on when it named Apple’s iPhone as the invention of the year. However, they may have blown it this year by bestowing the title on 23andMe’s retail DNA test. The test predicts disease risk and ancestral history by relying on a technology developed last century that has been applied to research this century. If direct-to-consumer genetic testing continues, physicians could have patients who have had a single-nucleotide polymorphism (SNP) scan. With the cost of sequencing genomes decreasing rapidly (now $30,000), what does this mean for you? 

Every cell in the human body carries an individual’s genetic information, and microarrays—which probe hundreds of thousands of gene markers simultaneously&mdash;can measure whether certain genes are “faulty.” Affymetrix, the first company to offer high-density arrays (>500,000 markers), combined its efforts with results from the Human Genome Project/HapMap to enable whole genome investigation. Pacific Biosciences developed rapid genome scanning, which could allow for the $100 genome within two years. Its technology relies on Mother Nature’s ability to rapidly copy a genome and merely eavesdrops on it to produce a clearer picture than a microarray scan. The real trick lies in interpreting this information and deriving clinical utility from it. The Genome Wide Association Scan was one of the first to utilize this technology and was recently used to identify novel molecular pathways in a cadre of diseases. This approach has the advantage of being an unbiased, comprehensive search across the genome for susceptibility alleles and has been successfully applied for many single-gene disorders. 

For common complex diseases, the message is not so clear. Even with positive links, using SNP for common disease testing may not be useful for clinical application. An 

 recently reported on the lack of significant benefit in diabetes risk prediction using chips similar to the one 23andMe off ers. Using microarray analysis may be interesting, but it has not been validated as a way to obtain risk estimates for disease. Despite this lake of granularity, Time has decided to name 23andMe—a company which sells this technology with little, if any, clinical validity directly to the public&mdash;as the invention of the year. Hopefully, they don’t end up with spit on their face. 

—By Steven A. R. Murphy, MD, founder/ president of 

The Case for Aggregating Health Data around Patients 

In 2004, President Bush promoted the idea of an electronic health record for most Americans by 2014. This set in motion a wide variety of initiatives and projects. The Office of the National Coordinator for Health Information Technology was established. A certification process was set up for ambulatory and hospital EMR vendors to ensure a certain level of interoperability between systems. There was a lot of talk about developing a National Health Information Network (NHIN) through the funding of Regional Health Information Organizations (RHIOs). Although a few RHIOs have become operational, many have failed, and the long-term business model for those that remain is illusive. 

As I’ve traveled the world, I’ve yet to see a fully developed digital health information exchange in any country I’ve visited, yet alone one that could scale to the kind of system we would need for all Americans. I’ve come to believe that developing a digital network providing for the free, bidirectional fl ow of health information between every physician, hospital, clinic, pharmacy, laboratory, imaging center, insurance plan, and everything else in the ecosystem just isn’t feasible at scale. Even if the technology existed to do this, the money certainly does not, and furthermore, there’s no business model to support the exchange of information between competing physicians, hospitals, and clinics. 

Fortunately, there is an answer to this dilemma, and I believe most pundits are coming to the same conclusion. Why not put patients at the center and aggregate a copy of their health data around them? Even among organizations that compete, few have a problem with sharing most, if not, all of the patient’s health record with the patient. Global technology companies have come forward with solutions like Microsoft HealthVault, Google Health, and medical record banking initiatives that make it possible for patients to securely store a copy of their personal heath information electronically on the Internet and to receive electronic copies of heath information from their providers. In the case of HealthVault, patients have complete control over who they share this information with (family member, care provider, or anyone else who needs to know), and when. It is also possible to connect a myriad of devices—like blood pressure cuff s, glucometers, weight scales, spirometers, and heart rate monitors&mdash; that collect health data and store this information where others who need to know can see it. Imagine a day when each of us has a PHR and an EHR in the “cloud” that is always available, whenever and wherever we might be. RHIOs and other health information exchanges could then focus on an achievable goal&mdash;unifying critical patient information for care providers in a region. 

I do believe that local and regional information exchanges make sense. First and foremost, we’ll never get where we need to be so long as health information exists on paper or is locked up electronically in silos. But I also believe that aggregating health data around the person to whom it belongs is not only a solution that scales, but is perhaps the only way we can attain the vision of a truly transportable, always available EHR for most, if not all, Americans. 

—By MDNG Healthcare It Advisory Board member Bill Crounse, MD, senior director of Worldwide Health for Microsoft Corporation

The healthcare world has embraced the principles of Web 2.0, even taking the liberty to rename it in its own image, Health 2.0. The idea is catching on, and conferences such as 

 are enjoying a record number of attendees. At one time, people argued that these 2.0 technologies were not sustainable for lack of a viable business model and source of financial revenue. Setting those fears aside, it looks like these user-generated platforms are here to stay with Health 3.0, and even some rumblings of Health 4.0 in the distance. What do all these fancy names mean? 

3. Health 3.0 = content + community + consumer-centric commerce 

4. Health 4.0 = content + community + working commerce models + coherence (connectors) 

The Health 3.0 concept, which incorporates a source of financial benefit into its models, is stepping out of the theoretical imagination and into the real world. 

 incorporates text messaging and AIM into its physician practice model. 

 provides qualified health professionals who answer online submitted questions for fees ranging from $9-15. 

 offers live chat with health professionals, charging by the minute. Other Health 3.0 approaches include 

Social Networking Is Just What the Doctor Ordered 

Would it bother you to know that your physician smokes cigars? That your gynecologist was a member of a group called “I Hate Medical School”? Should physicians share this kind of personal information on social networking sites like Facebook and MySpace, where patients could potentially see it? Many doctors are turning to physician-only networks to get away from the prying eyes of patients. After all, we are all human and need to relax, socialize, and talk about our children, work, frustrations, and hopes without being paranoid it is going to come back and haunt us. Three of my favorites are: 

iMedExchange is only open to practicing physicians. Chief Executive Tobin Arthur says that the company hopes to create a virtual version of the doctor’s lounge at a hospital. iMedExchange may not have the catchiest name, but it is one of my favorite sites. iMedExchange verified my identity with a phone call, checking that I was a physician and that I registered. They were the only site to do this. They also have a very impressive live chat with customer service. In development for more than a year, iMedExchange studied how sites such as LinkedIn, Facebook, and Craigslist could be applied to physicians, and it shows! 

The Student Doctor Network is an independent community of students, advisors, educators, and practicing doctors. The membership extends from college students to practicing doctors in every healthcare specialty. It is a wonderful resource for college students from hoping to get into medical school on through residency. 

On Sermo, physicians come together to talk about observations from their daily practice. Physicians can tap into the collective knowledge to achieve better outcomes for their patients. Physicians can benefit, too; I’ve seen burned out physicians get invaluable support on Sermo, which is now partnered with the American Medical Association. A visitor must verify that he or she is a physician before participating in the discussions. 

—By MDNG editorial board member Nancy Tice, MD 

Mobile Phones Will Revolutionize Your Practice 

Smartphones and other mobile technologies will become major tools for physicians for improving quality of care and communicating better with patients and colleagues. Indeed, mobile phones are rapidly morphing from forbidden gadgets in healthcare to the most prized clinical assistants, facilitating improved communication and mobile computing in medicine. 

Mobile phone-based solutions can be helpful to physicians and patients alike. For example, appointment management software allows physicians to automatically contact patients, reminding them of their appointments in advance and requiring them to confirm that they are on their way. This software has the potential to decrease “no shows” and excessive wait times. 

The ability to use a cell phone to access relevant patient data when in the exam room or during hospital rounds can dramatically increase efficiency. Using this technology, physicians can have inexpensive and effective mobile e-prescribing systems; access to key data, such as previous medications and possible interactions, which can reduce medical errors; and immediate access to important guidelines and protocols that can enhance care and reduce costs. Also supported are real-time charge capture systems and point-of-care documentation. 

Today, we see the beginning of a new range of disease management modules based on mobile phone communication. Successful programs have been demonstrated for diabetes, asthma, smoking cessation, and other conditions, with increased two-way communication greatly influencing results. Vitals and other data can be readily and automatically collected and transmitted for quick collection and processing. 

Patients want better communication than is possible in the few minutes available during a typical visit. In the near future, many patients will carry a copy of their personal health information on their mobile phone. Expect that patients will send their eligibility and health history data to your office before they arrive. There will be no cumbersome on-site collection of insurance information, demographic data, etc. Even more importantly, patients will start sending their “agenda”—the list of symptoms and problems they want you to address during the visit&mdash;in advance. This will change the workflow of your encounter. A patient may tell you about specific information she found on the Web, and your mobile phone will help you to check that data on the spot and respond accordingly in a timelier manner. Today’s software systems also allow any practice to set up preferred patient groups who, for an extra fee, are reminded to take their medications and have the option of dialing their doctor’s office directly with a simple code. This is just the tip of the iceberg. 

, which sponsors the annual TEPR+ conference (

) and recently established the Center for Cell Phone Applications in Healthcare (C-PAHC).  Mobile phones are rapidly morphing from forbidden gadgets in healthcare to the most prized clinical assistants, facilitating improved communication and mobile computing in medicine.

Some of the Top Health IT Stories from 2008 are discussed.

One Last Look back: The 10 Biggest Health IT Stories of 2008

Harriet Berman, PhD, executive vice president of clinical programs, The Wellness Community — Greater Boston, Newton, MA, explains the pros and cons of cancer patient blogging, as well as what oncologists need to know about the topic. 

1 What outlet does blogging provide cancer patients that they never had before?

The act of writing has been shown to be very healing and productive for people who have serious illnesses. One thing you’re doing when authoring a blog is writing, and you are taking your experience, and in a way, putting it outside of yourself so you can feel you have more mastery over it. It becomes something you can manipulate as you write about it, and one of the things about having cancer is this feeling that you’ve lost control.

One thing that’s hard for people when they become ill is that they begin to feel very isolated. They have the label “patient” slapped on them and become passive in the hands of the medical world; at the wellness community where I work, we try to help patients become “patient active” and get heard. Blogging is a chance to have your voice heard and explain to the world what the real experience is. I think there’s the opportunity to communicate about something that is essentially your whole life when there aren’t a lot of people who really either want to or are capable of talking to you about it in person. And it creates a community; bloggers need other bloggers. The public forum is the opportunity for people to say “here’s the reality of what cancer is like. I think you can learn from this. I think it’s important that my voice be heard. By writing about this, I make it less scary for everybody.”

2 What dangers are there to patients who write cancer blogs? 

I think the dangers are minimal. Th ey’re the same as any other danger that people face when they go public with anything, just as when they create a Facebook page or when they send an e-mail that they regret the next day. It’s not like people are posting their social security numbers. But in any public forum, you have to be thoughtful about what’s out there, because there could be a danger of a very blatant blog that says something nasty about a doctor, and that doctor could see it and become alienated.

There’s also a danger to other patients who read your blog if you post misinformation, or if you say something like “I would never go to ‘XYZ’ hospital again because all the people there are incompetent.” If other people read that, and that’s the hospital they go to, it may make them wonder about that hospital.

3 What should patients know before reading a patientauthored blog? 

Every person’s experience is different, and every cancer is different. If you read things that are alarming or of concern, go to your doctor and say “I read this. Can you help me out?” To some extent, maybe doctors aren’t thrilled with that, because they’re fielding a lot of questions that they wish their patient hadn’t read on a blog or on a support group’s website. But we live in the information age, and that’s something doctors should be becoming used to. The big thing is that what you’re reading on a blog is someone else’s experience; it may resonate with you, but it’s in no way predictive of what you can expect. What patients should look for is what they can learn from the author that will be helpful.

4 What do oncologists need to know about patient-authored cancer blogs? 

There are blogging tools that are well organized and passwordprotected that oncologists should be alerting their patients to, like carepages.com, caringbridge.com, and lotsofhelpinghands.com. By giving them these resources and by being familiar with them and others like them, they can know that their patients are blogging in a reasonably safe way.

Know what the resources are for your patients, in your community and online, and value that writing can be a very benefi cial part of their treatment. The Institute of Medicine published a report last year about how important it is to tend to the psychosocial needs of cancer patients and that if you’re not attending to that, you’re not attending to the whole person and the whole disease.

Doctors may not have time to sit with the patient and go over what they’re going to write in their blog, but they do have time to provide a brochure or a list of websites. Also, some patients have never thought about writing, but hearing from a caring nurse who says “I know other patients who found if very helpful” may help them feel hopeful and not so alone. People can never tell their story too many times; every time they do, they gain a little more control over it. There’s something about telling your story that helps people realize “I’m not just a cancer patient; I’m a person who has cancer, and I can tell people about it.”

Harriet Berman, PhD, executive vice president of clinical programs, The Wellness Community ï¿½ Greater Boston, Newton, MA, explains the pros and cons of cancer patient blogging, as well as what oncologists need to know about the topic.

MDNG Editors

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