Utilizing Web 2.0 to Bridge Healthcare Communication Gaps

Communication is critical to delivering accurate medical advice. In the overall healthcare process, timely, informed, and bidirectional communication is important not only between doctors and patients, but also between doctors and other doctors. In fact, 65% of medical schools now teach communication skills as a part of their common curriculum.(1) Not surprisingly, upon completion of medical training and entering into a medical practice, more time often is committed to the science of patient care and less consideration is devoted to facilitating this communication process. Resulting issues in intraorganizational healthcare communication are linked to a rise in medical errors. As Pirnejad et al.(2) point out, “Communication failures, particularly those due to an inadequate exchange of information between healthcare providers, remain among the most common factors that contribute to the occurrence of adverse drug events . . . [and] communication errors were found to be the leading cause [of in-hospital deaths], and were twice as frequent as errors due to inadequate clinical skills.” Furthermore, patient–provider communication is vital to improving adherence to medical instructions, establishing good clinical relationships, and fostering patient satisfaction.3 Prior research demonstrates that there is a positive correlation between effective patient–provider communication and improved patient health outcomes, and that effective communication can help improve a patient’s health as much as the actual medication.(1) Given the central role of the communication process in healthcare delivery, this article seeks to utilize the capabilities of Web 2.0 to help bridge harmful communication gaps.

What is Web 1.0?

The advent of commercial Internet usage enabled organizations to offer connected digital content and deliver this information to consumers with more timeliness, convenience, and detail than ever before. In the era known as “Web 1.0,” online content consisted of static websites, resulting in a one-way flow of information from the practice to the viewer. In the late 1990s and early 2000s, websites were easily created by electronically moving the material from the practice’s trifold, tricolor brochure to a widely accessible online platform. These ostensibly professional websites often were created by untried, self-taught Web designers who had little or no experience in building platforms specifically for healthcare purposes. These sites were inexpensive and even free to create, but they were not very effective in improving communication between the doctor and the patient.

Web 1.0 was focused on searches (i.e., the higher the site appeared on the search engine, the more visitors the site generated), which were assumed to translate into more patients calling to make an appointment. Importantly, Web 1.0 differentiated between organic versus nonorganic search results. Organic search results, positioned as content on the left-hand side of the search page, are those that appear because of their relevance to the search engine query. Nonorganic search results, also called pay-per-click, are actually paid advertisements that appear along the righthand side or top of the displayed organic search results (Figure 1). To reduce consumer deception, it is an accepted practice to identify content that is nonorganic by labeling the post an “ad” or indicating that it is “sponsored” by an organization.(4)

Figure 1. Organic versus nonorganic search results.

In an effort to more specifically target potential patients who may be interested in the practice, search engine optimization has the goal of placing the website on the first page of results for Google or any of the other search engines (e.g., Yelp, Bing, Yahoo). Search engine optimization is the process of improving the volume of traffic that is driven to your site through unpaid (i.e., organic) results, as opposed to paid (i.e., nonorganic) inclusions. This can be accomplished by making sure that content can be “crawled” by programs or automated script that visits websites and scans pages in order to create databases or entries for a search engine index by strategically crafting webpage copy that is autonomously searchable, and including terms that are likely to be of interest to potential patients.

The New Era of Web 2.0

The term “Web 2.0” was introduced in the first decade of this century, and has been defined as “a collection of open-source, interactive and user-controlled online applications expanding the experiences, knowledge and market power of the users as participants in business and social processes.”(5) When applied to healthcare, Web 2.0 uses modern cloud-based and mobile technologies to enhance communication via social media interactions and user-generated content contributed by doctors or the practice. In the early 2000s, following the widespread adoption of both the Internet and easy-to-use tools for communication, social networking, and self-publishing, media attention focused on increasing interest from patients, clinicians, medical researchers, and medical librarians in using these tools for healthcare and medical purposes.(6) These technologies have the potential to empower patients to have greater control over their own healthcare and decrease medical paternalism. However, the nature of Web 2.0 allows for the possibility of changing—perhaps even to the point of disrupting—the current model of healthcare delivery.

A key concept of Web 2.0 is that patients themselves should have greater insight into and control of information generated about them.

In particular, social media and blogs have caused a revolution concerning every aspect of social life and the medical aspects of patient care. Social media can be used to facilitate communication between communities of physicians and patients, or even to study the dynamics of blogs and their influence on patients’ knowledge and information-seeking tendencies. Social media are radically changing the way we communicate and the information spreading into contemporary society. The term social media is defined as websites and Internet tools that allow for users’ interaction through sharing information and ideas. These applications help facilitate communication among users by creating an accessible platform that is open to all. Social media also creates societies and networks based on socialization and participation. Hundreds of millions of users from different socioeconomic, political, and national backgrounds worldwide communicate using Web applications and technology. Blogs are personal websites consisting of thoughts, information, photographs, and personal ideas that are arranged in chronological order based on the most recent post. Most blogs allow visitors to add comments and ask questions about the content. Posting messages and commenting on blog entries form a direct line of communication between the blogger and the visitors. Blogs serve as a unique, self-publishing tool in consumers’ hands, and offer a creative public space for conversations concerning health and healthcare.

When considered in the context of healthcare, Web 2.0 is often given the specific nomenclature “Health 2.0.” The prominence of Web 2.0 in healthcare can be attributed to the availability and proliferation of applications across healthcare in general, and the potential for improving public health in particular.(7) Early examples included doctors, patients, and scientists utilizing a specific set of Web-based tools (e.g., blogs, e-mail listservs, online communities, podcasts, social media posts, videos, wikis) to provide accessible information to consumers. Using the principles of open source and user-generated content, the power of social networks was harnessed in order to personalize healthcare, collaborate, and promote health education.(8) Web 2.0 can incorporate multiple technologies specific to the healthcare industry, such as connected health, the EMR, mHealth, telemedicine, and the use of the Internet by patients themselves, such as through blogs, Internet forums, online communities, patient–physician communication systems, and other more advanced systems.(9) Thus, Web 2.0 is not only about healthcare providers having an increased ability to generate and disseminate information; it is also about patients being cocreators in this process.

Do Patients Benefit From Medical Gatekeeping?

One might question whether or not patients being active participants in the healthcare process is a benefit for society. A key concept of Web 2.0 is that patients themselves should have greater insight into and control of information generated about them. One advantage is that it empowers patients to have greater control over their own healthcare and diminishes the age-old paradigm of “the doctors know best.” Critics of these technologies have expressed concerns about possible misinformation and violations of patient privacy; however, as more patients become comfortable with the secure sharing of their health information, the concept of Web 2.0 is gaining more acceptance. Much of the potential for change that comes from Web 2.0 is facilitated by combining technology-driven trends such as the patient’s medical records, which “may lead to a powerful new generation of medical applications, where patients share parts of their electronic health records with other patients with similar medical conditions and ‘crowdsource’ the collective wisdom of other patients and professionals.(10) Thus, Web 2.0 has the potential to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.(11)

In the not too distant past, patient records were recorded on paper or on an EMR that could be accessed only by a physician or other medical professionals. Physicians acted as gatekeepers to this information, telling patients test results when and if they deemed it necessary. Such a model operates relatively well in situations such as acute care, where information about specific blood results would be of little use to a nonmedical person, or in a general practice where results were generally benign. However, in the case of complex chronic diseases, including psychiatric conditions or diseases of unknown etiology, patients were at risk of being without well-coordinated care because data about them was stored in a variety of disconnected places and, in some cases, might contain the opinions of physicians who did not share their thoughts and opinions with the patient. Increasingly, medical ethics deems such actions to be medical paternalism, and these actions are discouraged in modern medicine.(12)

Consider a hypothetical example that demonstrates the increased engagement of a patient operating in a Health 2.0 setting. Let’s imagine that a patient goes to see their primary care physician with a presenting complaint, having first ensured their own medical record was up to date by checking it using the Internet. The treating physician might make a diagnosis or send for tests, the results of which could be transmitted directly to the patient’s EMR. If a second appointment is needed, the patient will have had time to research what the results might mean for them, what diagnoses may be likely, and may have communicated with other patients who have had a similar set of results in the past. On a second visit, a referral might be made to a specialist. The patient might already have had the opportunity to search for the opinions or recommendations of other patients regarding the best specialist to go to, and in combination with their primary care physician decide whom to see. The specialist gives a diagnosis along with a prognosis and potential options for treatment. The patient has the opportunity to research these treatment options and take a more proactive role in coming to a decision that takes into consideration the opinion of their healthcare provider. They can also choose to submit more data about themselves, such as through a personalized genomics service, to identify any risk factors that might improve or worsen their prognosis. As treatment commences, the patient can track their health outcomes through a data-sharing patient community to determine whether the treatment is having a beneficial effect for them, and they can learn about research opportunities and clinical trials for their condition. They also have the social support of communicating with other patients throughout the world who have been diagnosed with the same condition. Thus, Health 2.0 has the ability to put the patient in the center of the process of their own healthcare and works in conjunction with the other caregivers so that everyone is essentially on the same page.

What Will Web 2.0 Do For Your Practice?

To start, Web 2.0 ensures that you stay informed of the latest developments in your particular field of medical expertise or interest. These communication technologies enable medical education through podcasts and other forums to allow physicians to enhance their learning at any time that is convenient for them. In the Web 2.0 era, the Internet allows collaboration and helps patients receive the information they need to actively contribute to the conversation when consulting with their physician. Web 2.0 enables patients who use search tools to find out information about a particular condition, be it a common one or an esoteric diagnosis that the primary physician potentially has not seen. Notably, even at the earliest stages of Web 2.0’s development, Google search engine results revealed the correct diagnosis in 15 out of 26 cases (58%, 95% confidence interval 38% to 77%).(13) Additionally, physicians can gain more detailed patient histories by having access to real-time patient-reported outcomes and continuously aggregating both patient and physician data for personal and scientific research. Data also can be aggregated for disease-specific communities and patients with rare conditions, with accurate information provided on treatments, symptoms, and outcomes, which may improve their decision-making ability or the likely success of carrying out scientific research such as observational trials.(14)

Of course, negative consequences from the use of Web 2.0 are possible. These might include issues around the loss of control perceived by doctors over patient information and safety, the dangers of patients acquiring or spreading inaccurate information, and concerns over medical ownership and privacy. Also, Google has limitations as a diagnostic tool for medical doctors, as it may be effective only for conditions with unique symptoms and signs that can easily be used as a search term. Studies of its accuracy have returned varying results, and it remains in dispute.(15) Finally, concerns exist about the quality of user-generated content leading to misinformation, such as perpetuating the discredited claim that the MMR vaccine may cause autism.(16) In contrast, a 2004 study of a British epilepsy online support group suggested that only 6% of information was factually wrong.(17) In a 2007 Pew Research Center survey of Americans, only 3% reported that online advice had caused them serious harm, while nearly one-third reported that they or their acquaintances had been helped by online health advice.(18)

Bottom Line: Web 2.0 creates two-way communication between patients and doctors or the practice. The concept allows feedback between both parties. As a result, patients are more involved and better able to participate in their healthcare decisions. This situation is better for patients and better for the doctor, who is now in the adjunct role, instead of the paternal role of “the doctor knows best.”

References

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14. Frost JH, Massagli MP, Wicks P, Heywood J. How the Social Web supports patient experimentation with a new therapy: the demand for patient-controlled and patient-centered informatics. AMIA Annual Symposium Proceedings. 2008:217.

15. Amri M, Feroz K. Google searches help with diagnosis in dermatology. Inform Prim Care. 2014;21(2):70-72.

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17. Health 2.0 : Technology and society: Is the outbreak of cancer videos, bulimia blogs and other forms of “user generated” medical information a healthy trend? The Economist. 2007;September 6:73-74. www.economist.com/technology-quarterly/2007/09/08/health-20

18. Metzger MJ. Making sense of credibility on the Web: models for evaluating online information and recommendations for future research. Journal of the American Society for Information Science and Technology. 2007;58:2078-2091.