Book Review: Macrowikinomics

The theory behind Wikipedia is that the wisdom of the masses is greater than that of a few ‘experts’.  Many people believe that Wikipedia has greatly enhanced the amount of knowledge available to the common man.  Others lament that the encyclopedia entries are not always screen and the quality of entries is highly variable.  Can online, mass collaboration lead to significant improvements in a variety of fields?  This is the propoistion advanced by the book Macrowikinomics by Don Tapscott and Anthony D. Williams.

Although I have not read the entire book, the section on healthcare offers innovative, although overly optimistic, ways to leverage online mass collaboration to improve healthcare quality.  Examples of healthcare websites where this type of mass collaboration takes place include:

  • PatientsLikeMe.  This site allows individuals with similar diseases to converse concerning their treatments and offer moral support.
  • WeAre.Us.  This site is like Facebook but works as a social support network for individuals with common illnesses.
  • WebMD.  Provides information on symptoms and treatments for various diseases.
  • RateMDs.  This site is like Yelp for physicians.  The user generated ratings can help you select your doc.
  • FluWikie.  This site is useful for tracking flu pandemics (e.g., H1N1).
  • Sermo.  This is a social networking site for physicians.
  • Hello Health.  This is a new form of web-based primary care where you can communicate with physicians via IM or email.  Physicians even make house calls.  I profiled Jay Parkinson years ago about his site.

The key problem that these sites solve is asymmetric information.  As a patient, your medical knowledge is limited.  Even physicians face the problem of asymmetric information.  Not all physicians may specialize in the specific disease you may have, and this can lead to misdiagnoses.  The internet can provide a wealth of information; but providing a means to access and organize this information in a useful means is imperative.  Hence the need for so many sites.

The authors recommend four key steps.

  1. Collaboration and Community.  The authors wholeheartedly support efforts such as Patients Like Me which not only provide moral support for patients with the same disease, but also provide information on treatment experiences.
  2. Personal Health Webpage. The authors support patients controlling their own health records.  The patient would be the one determining which physicians can access their records.  One problem with this system is that it relies on the patient to maintain the record.  Giving physicians access to a patient’s individual health webpage can allow them to update the patient’s records using appropriate terminology, but how to allow the right physicians and not con-artists to access these webpages is a problem.  The authors claim that your personal health webpage could also be the used for social networking on sites such as Patients Like Me.
  3. Massive Data Sharing for Medical Research. On the Patients Like Me websites, patients document how different treatments affect their health.  All this information could be used to improve medical research.  Again, the key is to ensure patient confidentiality is protected, while giving researchers the access to the most up-to-date information available.  Although this data may not be useful for initial FDA approval of a drug, it would be extremely valuable for post-market surveillance.
  4. Engagement of Medical Professionals.  Physicians or nurse practitioners should be made available around the clock to answer patient questions.  They can serve as triage to determine whether the patient should see a doctor, go to the ER, or should wait to see if the symptoms resolve themselves.

One question is whether vested interests will kill these technological innovations.  For instance, “as recently as 2001, the American Medical Association told the public to ‘trust your physician, not a chat room’ stating that the information found online puts ‘lives at risk.'”

In addition, existing infrastructure is not currently set up for this type of open-source technology.  For instance, Matthew Holt of The Health Care Blog, states the following: “Say you were a member of Aetna and you want to go to Blue Cross, or if you’re at one hospital and decide you want to switch to another hospital across the street.  Both of these are basically impossible, even though everyone says they want to do it.”

Overall, the book does a good job of presenting opportunities where crowd-sourcing can be useful.  In terms of actually implementing these technologies into the existing health infrastructure, however, the authors are less specific.  Still, this book is worth a read to make oneself aware of all the amazing technologies that have been developed.



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