Life in the Fast Lane

With the era of Generation Y doctors; open source publishing; micro-blogging; stumbling and tweeting now upon us it is important to review the potential implications of the internet age on emergency medicine.

The generational transition behind this digital revolution has already occurred in many other employment sectors and as emergency physicians it is important to stay in touch with developments - we are not immune to the effect of the internet on our daily work practices.

The development of web 2.0, Medicine 2.0 and the new generation of web services will play an important role in the future of medicine [Reference]. These web tools, expert-based community sites, medical blogs and wikis will facilitate the rapid dissemination of information and reduce the work of physicians, scientists, medical students and medical librarians.

The current era of internet (web 2.0) is not just a conglomeration of websites with more aesthetic interfaces, more curved textboxes and enhanced reactivity but is an evolutionary response to a generational change. The development of web 2.0 has led to more formalized and dynamic information sharing and creation, and has transformed websites from isolated information silos to interlinked computing platforms. In essence enhanced online collaboration now enables individuals to take control of the content on the web.

The exponentially expanding array of high quality clinical media such as digital imaging, audio podcasts, shockwave flash animations and streaming video are set to redefine medical learning and the medium of distribution is the internet. Content is being presented in readily editable; easily assimilated; ‘bite-sized’ chunks for immediate online consumption. Synergistically the ‘wisdom of the crowds’ model of social interrogation is allowing the best of this material to preferentially rise to the top of our search horizons.

How is this relevant to you? Because the format of information presentation has changed;  the ‘ownership’ of collated musings is being revoked and the ways in which we are able to organise, store, retrieve and share relevant resources has been re-invented. The days of html-link cluttered desktops, water cooler gossip and filing cabinets packed to the rafters with photocopied journal articles have gone - or at least they should have!

Information collated in databases and websites is now subject to rapid dissemination through web-logs (blogs), RSS (Really Simple Syndication) and social bookmarking feeds. Lengthy delays in physical press publication and the peer-review process are being bypassed via open-source channels with dramatic effect.

The majority of blogs provide information, updates and views on a particular subject matter. A typical blog combines text, images, and commentary to create a brief and informative article. Initially these erudite musings were deemed to be solely the domain of the ‘demonic ubergeek’. However, with the advent of the WYSIWYG (what you see is what you get) text editor and free online blogging resources such as wordpress.com, blogger.com and MedBrains.net the blogging process has been inherently simplified and the emergency medicine blogging community is slowly expanding.[Australian MedBloggers]

Blogs can be entertaining and informative, offering insightful views, opinion and rhetoric. Most medical bloggers adhere to the ‘Healthcare Blogger Code of Ethics‘ (’MedBloggers Code’) and comply with the rules and regulations of the Health On the Net foundation (HON). The HON was created in 1995 to ‘promote and guide the deployment of useful and reliable online medical and health information, and its appropriate and efficient use’. HON is a non-profit, non-governmental organization, accredited to the Economic and Social Council of the United Nations. However there is some controversy as to the dynamic effect that MedBlogs will have upon physicians, patients and the physician-patient relationship [ACEP Reference] [MedBlogger response to ACEP] Anyone considering entering the blogging arena must read ‘Blogging Myths Debunked‘ by Dimov.

Faced with this tsunami of rapidly growing information the humble physician may feel overwhelmed, but help is at hand. Most blogs, micro-blogs and news aggregators provide access to an RSS document (called a ‘feed’ or ‘channel’). Once requested, an RSS feed is delivered automatically to your preferred feed reader (e.g. iGoogle or PageFlakes) as either a summary or as the full text article from the affiliated website. You can then choose how, when and where to indulge your information consumption. Typically a 20 minute review of your feed reader content will keep you up to date with new postings from your favourite medical blogs. RSS feeds are now provided by most leading online medical journals and medical resources on the internet, such as PubMed, the BMJ and Medscape. Personally I enjoy an eclectic mix of feeds ranging from health news sites such as New York Times Health and MedPage Today through to health commentary sites such as Dr Rant, ScienceRoll, HealthInformatics, ScalpelsEdge and Scanman.

Yet this is but the tip of the MedBlog iceberg. To really explore the expanse of health information you have to enter the realm of the feed aggregator site. Feed aggregators constantly trawl the blogosphere for new feeds and health related information. The most comprehensive of these aggregators is MedWorm.com which accesses over 6000 authoritative data sources a day. From the data collected, MedWorm provides new outgoing RSS feeds on various medical categories (e.g. emergency medicine) that you can subscribe to in your own feed reader. Too complicated? Then go to AllTop.com and in the health category you will find displayed the latest 5 articles from each of 150 medical journals and websites.

Another great way to keep up to date with MedBlogs is to follow Grand Rounds. Grand Rounds is the weekly collection of the best in online medical writing. Each week, a doctor, nurse, patient or healthcare professional hosts Grand Rounds and compiles links to noteworthy posts about medicine.

Less dynamic, yet none-the-less information packed and up to date is the ‘wiki’ - a software tool that allows users to easily create, edit, and link pages together. Wiki is derived from the Hawaiian word for ‘fast’, although some have suggested that wiki means ‘What I Know Is’ this is a backronym. Wikis are often used to create collaborative websites and facilitate structured repositories of collated online information. The best known of these wikis is Wikipedia and soon to follow will be MedPedia. In Australasia Dr Gary Ayton is doing a sterling effort in collating the first online emergency medicine wiki in Oz eMedicine.

Medical blog sites are also developing into more advanced information repositories pooling their written pages with other webpages to create aggregated learning resources, which are readily updated, and extensively referenced. A good example of the blog-based approach to medical information provision is the clinical cases website hosted by Dr Ves Dimov.

Doctors and medical librarians are busy people and often do not have time to read or write long posts. Twitter is a free social networking and micro-blogging service where users send and read updates (tweets) and pictures. I am currently all a twitter with tweets, twurls and twitts having recently been introduced to the twitter phenomenon. The 140 character posts on Twitter are enough to share interesting bits of information that otherwise would have gone unpublished and are often the formative foundation of future blog posts and clinical research. A recent trend has been to post to the Twitter community (tweeple) using the iPhone and other portable devices ‘live’ from medical conferences.

The most useful tweets contain shortened urls to documents and articles that your friends are currently reading. This provides a massive collaborative reading pool from which to draw inspiration and knowledge. However, it is important to choose the tweeple you follow very carefully to prevent being bombarded by inappropriate messages describing the mundane daily routines of other twitts.

With a deluge of data now online, increasingly sophisticated professional search engines are being created to provide access to diagnostically accurate, peer reviewed and validated information for physicians. The race is on to find the most efficient way for health professionals to search for clinical images, textbook/journal articles or answers to key clinical questions. Traditionally this search has been labour intensive and frustrating unless searching for a specific journal article or the user is happy to sift through hundreds of abstracts to find the right articles to review.

Classically physicians search the web for medical information using locally hosted library sites, PubMed, MedLinePlus, MD Consult or a generic search engine such as Google. However, with the development of ontological and semantic data tagging, deeper and more complex interrogation of the wealth of defined medical knowledge is possible.

Cognition’s semantic natural language processing (NLP) technology adds word and phrase meaning and understanding to computer applications. Using a mix of linguistics and mathematical algorithms Cognition.com has effectively taught the computer the meanings of words, word associations and context.

Semantic search uses knowledge of the relations between words and phrases (a “finger” or a ‘digit’); taxonomy (a ‘finger’ is part of a ‘hand’, a ‘cow’ is ‘bovine’ and is a ‘mammal’) and syntax (grammatical structure) to enhance search refinement. This allows the user to type a specific ‘question’ into the search engine rather than entering a disjointed series of non-sequiturs. Such engines are still in early beta development but initial results are extremely promising.[10]

One of the best examples of fully functional medicine 2.0 semantic search is GoPubMed.org. It is a knowledge-based search engine for biomedical texts based on GO (gene ontology) and medical subject headings (MeSH). GoPubMed retrieves PubMed abstracts from a search query and delivers relevant results in the categories of ‘What, Who, Where or When’. The search is simpler and more efficient than using PubMed alone and using the search refinement functions produces a highly relevant shortlist of search returns.

Once you have sourced your information, the web 2.0 structure encourages users to collate, tag, annotate and share pertinent resources. However, with a plethora of social bookmarking and tagging domains available online it can be difficult to know where and how to start. I have slowly developed a routine for collating, highlighting and annotating results from the pixelated universe with combinational collation using the browser based tools of Stumble Upon, Delicious and Diigo. Working with your friends and colleagues to read, review, digest and share online resources is a valuable learning experience and when done collaboratively becomes an essential future-proofing skill.

Social bookmarking tools such as Delicious and Diigo rely on the user to tag articles, images, documents or websites with keywords. Instead of saving a webpage resource as an html-link to your desktop or embedding the link in the browser toolbar your link is now saved to a virtual server to be retrieved from any computer, PDA or phone when required. The social aspect of bookmarking is the ability to share your discovered resource with like-minded colleagues with a single click. When used collaboratively study groups can rapidly research, review and share resources so that searching for a website tagged with ‘anatomy, MCQ, board certified’ will yield informative results.

I find that reading becomes social when information, knowledge and community come together. The ability to highlight text and annotate with sticky notes online retains contextualization that is often lost when ‘clipping’ text and iteration with group research becomes a high yield and rewarding task.

The integration of medicine 2.0 with our daily work routines may appear to be a complex and non-intuitive burden. However with the deployment of progressive and adaptive internet based tools; the integration of high quality media and the evolution of semantic search - the web 2.0 rollercoaster is definitely a ride we should take. If we all embrace the attitudinal wind of change and combine collectively, we will reap the benefits