SixthSense Technology – A Whole New Web

The Web now is crude. Desktops and laptops tie you to a typewriter. Mobile devices tie you to tiny typewriters. From our perspective, the Web is two-dimensional.

Pranav Mistry, however, wants to liberate us from the two-dimensional Web. How? With something he calls SixthSense technology.

Rather than reading me blather on with a textual description of his vision, why don’t you just take a look. (If you can’t see the video, check it out over here.)

I’m already envisioning health care applications for this technology – tons. What about you?

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How to Make Health Care Remarkable – the @ePatientDave Interview

epatientdaveDave deBronkart is a Freedom Fighter. In 2007, Dave battled metastatic cancer and emerged a passionate advocate for leveraging the Web to connect patients with the content and support and inspiration they need to cope with the human consequences of disease.

The Web has brought forth new ways of connecting the world and brings with it questions and answers about how to safely and effectively extend the power of health care from face-to-face meetings to remote but important regions of human experience. It’s important for us to understand the integrative nature of health care: no single perspective will yield approaches that work. Rather, we will need the perspective of all participants.

Nevertheless, the view of patients is paramount – how they respond to disease processes, what they need in terms of information and care and why their unique psychological responses to treatments must be carefully appreciated. We need, therefore, for patients (who are ourselves) to be actively engaged in the evolution towards remarkable health care. Because if health care isn’t remarkable, it’s probably dangerous.

Therefore, since patients are central to health care, we must listen to them as they offer their time and passion and ideas. The novel concept of epatient is part of the new landscape of discussion currently taking place in health care. The idea of “e-patient” has emerged in recent years. But what exactly is an e-patient? What does the “e” stand for? It may not be what you think. Which is why I asked Dave to tell us his story, his definition of e-patient and his hopes about health care in the 21st Century.

THE INTERVIEW

You seem to have received a lot of attention as a passionate leader in e-patient health. What got you started in your advocacy?

When people asked JFK how he became a war hero, he said “It was easy – they sank my boat.” Same with me: I was minding my own business, then a lucky shoulder x-ray incidentally revealed kidney cancer that had spread to my lung – and other lung, and skull, and femur and arm. I was dying. And suddenly I really cared what could make a difference, and I pulled out every trick in the book, every resource at my disposal.

I used the internet in every way possible, from making sure I had the best possible doctors to finding other patients to forming social communities and reading my hospital data online. And when it was all over, I learned that what I’d done was the definition of an e-patient.

So I started calling myself one.

It’s funny, because some people think I started e-patients.net. Hardly. To the contrary, my doctor was a member. I’d already been blogging as “Patient Dave,” so I just added the e.

What’s your definition of an epatient? What are the major hurdles patients have with respect to online interactions?

“Doc Tom” Ferguson, who died in 2006, was the founder of the e-patient movement and creator of the term. He said e-patients are Empowered, Engaged, Equipped and Enabled. Lately many people have added Educated, including about Evidence.

Today the first E’s are being empowered and engaged in your care. In a way the internet is almost incidental: people use the internet for everything, even ordering pizzas, so we naturally use it as patients too.

Note that this empowering patients has nothing to do with disempowering physicians and nurses; this is participatory, collaborative, a partnership. That’s why, when Ferguson’s “e-Patient Scholars Working Group” incorporated this year, we didn’t name it Freedom From Physicians – it’s the Society for Participatory Medicine. In Ferguson’s white paper, Conclusion #7 was “The best way to improve healthcare is to make it more collaborative.”

Hurdles? The main hurdle most new e-patients overcome is, as my doctor puts it, “embracing knowledge symmetry” – the idea that they have something to offer, that knowledge flow isn’t a one-way street. That’s the Empowered e. And then there’s realizing it and getting off your butt, getting engaged in your care and your overall well-being.

It’s about realizing that we as individuals, empowered by the internet, now have much more to contribute to our care than we realized.

A hundred years ago – perhaps even fifty – access to real medical information indeed came only through medical schools. But today the internet has connected us with facts and with each other, and that has truly changed everything. If you doubt this, read the e-patient white paper – written mostly by physicians – titled “ e-Patients: How They Can Help Us Heal Healthcare.” It’s free, at the top of e-Patients.net.

Of course, access to information online doesn’t make you brilliant any more than access to books does. It enables you, if you’re equipped. So the next hurdle for some is to realize they don’t know everything. But if you’ve got a participatory empowering physician, that’s easy: you ask “What do you think about this?”

What have been the reactions to your efforts by healthcare professionals? What’s your sense of the industry’s receptivity to the e-patient movement in general?

Providers have been great to me – at least the ones who speak to me. :-) And I really can’t speak for or about anyone I haven’t spoken with.

I’ve seen enough change in industry – since before the first PC – to know change can be hard. Imagine spending your life getting good at the waltz, then learning to twist, then falling into a mosh pit. Yikes. That’s why Kaiser has reported that of the $6 billion they spent on their EMR, only 1/3 was spent on the equipment; the rest has been people issues.

The great  @TedEytan (TedEytan.com) put it this way: “People don’t know how to dance to this new music yet. Teach them.” And that is the job of the Society for Participatory Medicine. Call it “dancing lessons” if you want.

Which technologies in health care do you feel are the most effective in enhancing the ongoing relationships between patients and healthcare professionals? Are there some characteristics of patient-provider relations which technology can’t address?

Email and social media are already making it infinitely more efficient for patients and providers to connect for non-urgent issues. Kaiser has great data showing that email reduces office visits and lets questionable symptoms be raised earlier, because the logistical hurdle of that first touch is so small.

I just about puke when I hear dino-physicians whine about “I’m not gonna do email [which my patients want] because insurance won’t pay me, and I’m not doing anything I don’t get paid for.” This is the sound of a dinosaur dying – dying of FFSS, “Fee For Service syndrome.” It is the bellows of dysfunction, echoing forth from a system that is optimized for anything except getting care delivered to the people who need it. I am about to start calling for providers and patients alike to protest in disgust against the symptoms of FFSS.

The hell of it, for providers, and yes I mean you, hospital executives and physicians and everyone, is that if you are stodgy and behind the times, you may get blind-sided: your market (your customers, your patients) is (a) adopting new tools far faster than you are, and (b) moving through the age pipeline far faster that you realize.

Look, this year’s med school graduates cannot remember when there was no email! Yet just this week a friend’s surgeon’s office claimed “We don’t have access to email.” Really? A business in 2009 that doesn’t have email? Or were they just lying?

Either way, those days are ending. Bye-bye, FFSS. Consider: there is no clinic environment (Mayo, Geisinger, etc, where the docs are employees) that doesn’t do email. Why? Because when you’re paid to keep people well, you don’t mind hearing from them.

But no technology will replace the human skills, human intuition, human touch. It’ll be a long, long time before technology replaces Dr. Danny Sands, Dr. David McDermott, Nurse Practitioner Mee Young Lee.

In The Innovator’s Prescription Christensen and Hwang talk about the difference between “precision medicine” and “intuitive medicine.” Precision is the stuff that’s well understood now, from colds to knee replacements and even much cardiac surgery, I’m told. Those things are pretty much handled routinely. But the mind, heart, and compassion of a great nurse or MD will not be replaced by robots.

What’s your dream for the future of patient care?

Participatory medicine: a new, empowered partnership that is far more satisfying to both providers and patients. The Society’s new Journal of Participatory Medicine will advance our knowledge of how to make patient-provider relationships more effective.

Not surprisingly, the Journal is wide open to contributions from people who have any kind of work in this field. Because it’s new, we’re open to well thought out exploratory and observational submissions as well as controlled trials. We have a fully transparent peer review process, open to all sorts of participation, including reviews by patients. So speak up, submit, contribute!

Our vision – my vision – is that in partnership, we’ll all have a lot more fun and feel less burden – because we have new partners.

FOLLOW THE LEADER

If you’re interested in how we can lead health care forward – as patient or provider or entrepreneur – you can follow Dave on Twitter:  @ePatientDave and subscribe to his blog.

Today and tomorrow (November 12, 13 2009), the FDA is holding Public Hearings about Social Media. It would have been nice to see much more patient representation, since there is a very real chance that both FDA and the industries it regulates are each overlooking the wider opportunities they have to be remarkable online and offline.

My personal concern, is that the shadow of  Edward Bernays – specifically his legacy of Social Engineering to consumerize and shape mass opinion and perception and behavior – will continue to follow Pharma into the 21st Century.

Pharma’s task is to produce safe and effective products and services for patients. FDA’s task is the ensure that Pharma’s claims and its products are in fact safe and effective. But both groups were forged in the mass medium broadcasting days of the 20th Century. The Web is radically undermining that model and demands radical re-thinking about the generation, exchange and consumption of information. We must have the participation of Freedom Fighters like epatients who can liberate us from the manipulative forces and tendencies and temptations which 20th Century media brought forth into our world.

It will take the brilliance and commitment and creativity and ethics of the life scientists and doctors and nurses and engineers (and marketers) to set the tone for how Pharma and related industries continue to heroically fight disease and help alleviate the suffering of tens of millions of people. To that end, we will need to create communities where patients can exchange perspectives with the people who dedicate their lives to improving the quality of health care.

Thank you, Dave for telling the world your story, for your dedication to helping those who suffer, and for giving hope in a time of upending change.

So what are your views on the e-patient movement? Is it on the right track? Who are your heros who are helping us move toward a healthcare system we can call remarkable?

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An Interview of @EndreJofoldi of HealthMash

The Web abounds with health care information (good, bad, ugly). In fact, for all practical purposes we have an infinite abundance of content on the web. And this abundance has produced a scarcity of meaning, relevance and reliability. So any attempts to provide searchers of content are welcome efforts.

THE WORLD WIDE HEALTH WEB

HealthMash is one of the newer search engines for health care content and media by a team from Hungary and the US. HealthMash returns an array of finds and displays them within categories. Here in the US, most of the Web products that receive the most attention come out of Silicon Valley. What goes unnoticed is just how much remarkable work gets done around the world. Hungary, for example, has traditionally had one of the highest per capita rates of mathematicians. So it’s encouraging to see these products being developed internationally. And in the arena of health care and social software, Dr. Bertalan Mesko ( @Berci on Twitter) is doing amazing things with ScienceRoll.

HealthMash enables users to search generally, or ask the engine to return results garnered from Twitter or for Video for Images or Drugs and other contextualizing formats. Here’s how HealthMash presents Cystic Fibrosis within its Clinical Trials results (click to enlarge):

HealthMash Search Result for Cystic Fibrosis

Contextualizing information is an important process, especially since we now have so many sources of potential information. I won’t review the reliability of the results here, but I recommend test driving the interface. Another service that attempts to bring context and curation to health care search results is iTriageHealth.

For now, I’ll let Endre Jofoldi of HealthMash (@EndreJofoldi on Twitter) explain more about the product he and his team are working on. My hope is that these interviews engender entrepreneurial interest in the what I’m starting to call the Health Web. By the way: If you’re a developer and seek funding, I recommend following Robert Scoble’s  Twitter List of Venture Capitalists. Yes, Twitter has its uses. :)

THE INTERVIEW

You seem to be passionate about the Web and building custom search engines. Tell us about yourself – where are you from, what you do and what got you interested in health care and web technologies and communities.

The HealthMash “virtual team” in the US and Hungary consists of experts in medical informatics, computational linguists and software developers. Our individual team members have worked on many health related projects at the National Institutes of Health and the National Library of Medicine, thus we have first hand familiarity with the challenges of the health arena. Although most of our team are relatively young and healthy, a couple of the “old timers” have had enough health problems themselves and in their families, to have special empathy for all patients. So as you can see, we are naturally interested in web technologies and health communities.

HealthMash, which bills itself as a Revolutionary Health Knowledge Base and Semantic Search Engine, piqued my interest. What inspired you to build this type of search  engine? What does HealthMash do that other health search engines don’t? What technologies are under the hood?  What are your plans for HealthMash?

There are thousands of good health sites on the Web, like Medlineplus.gov and the MayoClinic,com, however they are limited in their scope and coverage. There are also tens of thousands of sites that offer questionable or harmful health advice. At the same time, we also know that even the best health practitioners can’t keep up with all the new developments in biomedical research and apply all that knowledge to the individual needs of patients. Our inspiration was our own health concerns and the inevitable health problems of our families and friends and fellow human beings, to envision a web site that offers the most comprehensive and most reliable health information to enable informed personal health decisions:

  • Thus, our goal with HealthMash has been to interpret the meaning of health related queries and, using our proprietary semantic search algorithms and bring together all kinds of potentially relevant information for the user (trusted health information, News, clinical trials, the research literature etc.)
  • Another important goal has been to support user exploration and discovery. HealthMash facilitates serendipity and discovery via our automatically generated  Health Knowledge Base which contains millions of relevant associations between health concerns, treatments, drugs and alternative medicine approaches, to name a few.
  • It is the sum of all of the content and technological innovations “under the hood”, and our passion for promoting healthy living, that distinguishes us from the competition.

Do you see it primarily as a stand alone search engine or are you considering developing social features into the service?

First I would like to turn this question into a bit different direction. HealthMash can be utilized by other search services. Our Explore and Discover section is also available through an API for third parties to embed it into their medical databases and search systems. To answer your question, developing social features into HealthMash has been planned from day one, but not implemented yet. As a matter of fact, our Hungarian health sites already have some social features in them (http://varoszoba.hu means “Waiting Room” and http://dokim.hu means “My Doc” ).

What other projects are you currently working on? If you had the necessary resources to build your dream health care technology/application, what would it look like and what problems would it seek to solve?

HealthMash keeps us pretty busy, given that it is in beta stage. And of course we also have to make a living, so we are working on “bread and butter” custom search and federated search engine projects for paying customers both in Europe and in the USA. If we had the necessary resources – and frankly we are hoping that a major player or venture capital firm will provide those resources to us sooner or later – our “dream” health care application would be to add sufficient intelligence to HealthMash to be able to answer any health related question and do it in all languages and all countries of the world.

Thank you, Endre. Keep us up-to-date. And good luck to your team. For more, you can always follow  Endre on Twitter.

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An Interview with #hcsm Founder @danamlewis

In the last 18 or so months since I blogged about health care and social media from a nurse’s perspective, I’ve seen a jump in interest in how we can mashup healthcare and the Web. Every new territory needs its leaders. One such leader is my friend  Dana Lewis who founded a Twitter chat focused on social media in health care communications. The chat is called Healthcare Social Media and uses the hashtag  #hcsm to rally participants in a weekly conversation Sundays at 8:00pm Central. She recently won the 2009 Excellence in New Communications Award from the Society for New Communications Research.

Dana started #hcsm out of conversations she had with communications consultant  Arik Hanson (a great man to follow on Twitter, especially if you’re interested in 21st Century Public Relations). Twitter chats offer a way for people with shared interests to exchange knowledge and advance a field of study. After starting #RNchat, I gained an appreciation for how these chats are moderated. Dana’s moderation has been an important inspiration and model. So I decided to interview her and it’s my pleasure to bring you the interview.

[UPDATE: Dana made a comment about one of the many people who helped her with #hcsm which I want to highlight. Here’s what Dana had to say about  Tom Stitt, CEO of Aperial:

he and his company Aperial have given #hcsm it’s home away from Twitter & tons of technical support. There are dozens of others who have contributed to #hcsm and supported the development of the model, but he’s at the very top of the list!

Tom has been an important contributor to the healthcare social media community and I agree with Dana that his efforts deserve special recognition.]

THE INTERVIEW

You’ve developed quite a following with the Health Care Social Media Twitter chat . Tell us about yourself, your passions and your goals.

DANA: I have a motto: “Doing something for someone else is more important than anything you would do for yourself.” This applies to volunteering for the American Diabetes Association, building the healthcare communications community on Twitter to break down barriers in the industry, and everything else that I do. I am a senior at the University of Alabama graduating in May with two bachelors degrees in Public Relations and Political Science from The University of Alabama. Currently, one of my immediate goals is full-time employment when I graduate, but I don’t believe my full-time experience in communications should be any different from my other experiences in that it will ultimately benefit people both now and in the future.

What got you interested in social media and health care?

DANA: My interest in social media and healthcare mostly stems from my interest in health – which started when I was diagnosed with type 1 diabetes during my freshman year in high school. I have always been a communicator and very passionate about making sure everyone has the ability and right to share their voice. Social media is a natural fit for this passion because it gives me – and everyone else – the tools to share our ideas and insights. Healthcare is obviously a daily part of my life with diabetes, so it is a seamless integration with my other thoughts and experiences on the Web.

As someone who recently started a Twitter chat, I can appreciate the little challenges of moderating and running them that may not be apparent to participants. What have been yours? Tell us about your approach and the tools you use to pull of the chats.

DANA: My biggest challenge for moderating a Twitter chat is spammers – but not in the traditional sense. I have a extremely low tolerance for shameless self-promotion. Personal promotion on occasion is pushing the edge; but companies who tweet to the hashtag about their product, service, clients, etc. are definitely spam. We started as a single conversation, but #hcsm has grown into a community and I am sensitive to protecting it from those who want to “monetize the ROI” of their Sunday evenings.

Other challenges include those who don’t understand the purpose of #hcsm, and get frustrated that we aren’t discussing healthcare reform or their speciality. Because we have such a diverse community (students, doctors, lawyers, non-profits, HC orgs, marketers, etc.), we have a diverse suggestion of topics and thus a diverse discussion. Sometimes those new to the conversation don’t see direct relevance of the first topic and try to flame the discussion so they can talk about something they understand.

My approach is simple: I use Twitter.com to log in to  @HealthSocMed to moderate the discussion. I put out the links to FAQ posted on our site & past transcripts, and try to answer any questions I can about the goals and workings of the discussion on Sunday nights. Participants are the ones who submit topics for discussion; I pick an average of 3-5 for each evening, toss them out, and we have a great conversation!

What’s been the feedback from the community about #hcsm? What value do you think participants derive and how do you think these kinds of chats will evolve?

DANA: The feedback from the community has been incredibly positive and supportive. There is always room for improvement, and we definitely have improved the way #hcsm works since it started back in January. #hcsm gives everyone the opportunity to open-source their problems or questions about the industry and anything related to healthcare communications and social media. There has been nothing like it to my knowledge on Twitter or elsewhere. By using Twitter, it breaks down the age, experience, geographic, and other barriers that often hinder an open dialogue. Anyone and everyone can participate and add value to #hcsm, which is the value in itself.

Chats are going to continue to evolve. We may shift from using Twitter to other tools, but the idea behind #hcsm to break down barriers and to build a conversation will remain the same.

Is PR dead?

DANA: It’s far from dead; PR has shifted, but I think this is a benefit for all. Instead of one-way push information from every channel possible, we have shifted our mindset to adapt and allow for relationalizing communication with different groups of people. I personally love figuring out how I relate to different groups of people; this is why I have a natural love of PR. Those who may be stuck in the traditional mindset of pushing information need to adapt – but the same applies to marketing & many other fields that involved communication and reaching people. PR is continuously evolving and will continue to adapt to the needs & desires of the publics that we relate to.

THE FUTURE OF HEALTH CARE & SOCIAL MEDIA

Health Care is a very wide field and there’s no shortage of opportunities for integrating social software into the various niches of what we refer to as Healthcare (as an industry). The rapid evolution and expansion and infiltration of the Web means that the industry is going to have to pay attention and invest efforts into understanding the radical shifts which electronic connectivity is inducing in the world.

In my opinion, the most cost-effective use of these media right now is using them to convene groups of bright people to explore, share and advance ideas which make differences. Twitter chats represent a novel approach to cultivating the world of fresh ideas and we owe much gratitude to leaders like Dana Lewis who are showing us, every day, how to forge ahead through the dangerous opportunities the Web is weaving in front of our eyes.  Follow, thank and retweet her.

Thank you, Dana!

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Zen and the Art of the Tweet

I’ve been thinking a lot about the nature of our collective mindfulness lately. Every month, millions of more people are increasing their connectivity to the Web. Facebook’s gravity keeps swelling. Twitter continues to flap upwards in users. Mobile devices and operating systems continue to evolve and proliferate. It seems every week a new feature or service or gadget makes a debut.

The Web is not only expanding like a universe but it’s also infiltrating every nook of our daily lives. And it’s expanding and infiltrating at an accelerating pace. What effect is all this happening on our capacity to attentively engage with life? What disciplines and skills and understanding do we need to acquire as the Web continues its unstoppable inflation?

PRESENT MOMENT, WONDERFUL MOMENT

Thousands of years ago certain cultures around the world discovered and cultivated the art of breathing mindfully. In some cases, entire religious traditions grew out of these practices.

Our brains and sense-organs are powerful attention-devices. Our minds are always teaming with thoughts, feelings, hunches and visions. Even asleep, our brains actively stream profuse experiences like dreams. It’s how we survive.

But our very powers of attention and awareness and cognition can distract us from the present-moment happenings of our lives. We’re always breathing, but rarely notice unless we pay attention. And this presents us with a fundamental observation about life: if we’re constantly processing the relentless influx of internal and external sensory data but never focusing our full attention on what happens, how alive are we? For to have a meaningful life, we must feel alive – otherwise we’re just automatons obligated to the patterns made by others and the larger external world.

Being aware of the present moment is the easiest and hardest thing to do. Try it: sit for 5 minutes and pay attention to nothing but your breath. How many times did your mind wander from that simplest of tasks? If you can’t pay attention to your life right now, when do you expect to do it? After you die? In some other world?

TWITTER MIND, MONKEY MIND

Some Buddhists have a phrase for how our minds endlessly flit from one thought to the next:  Monkey Mind. One aim of meditation is to “tame” the Monkey Mind. Not so much to control it, as to pay attention to it – and, in the process of paying attention to a fast-moving mind, paradoxically slow it down to a point where the present moment reveals itself most fully.

Of all social networking sites, perhaps Twitter best exemplifies the electronic version of Monkey Mind. The tiny bursts and pulses of text and hyperlinks stream through the world like flashes of thought across a busy mind. Twitter’s a powerful way to connect with others and receive news and important or trivial nuggets of information. And yet, if you’re not paying attention, it’s easy to get sucked into Twitter Mind – an energetic state of dopamine excitation, where the sense of time is lost.

As more of us use these tools, how do we maintain our sense of mindfulness? How do we tame Twitter Mind? Few of us practice any sort of traditional meditation to discipline our Monkey Mind. Now we have social media. The Social Web is like an extension of the neocortex. It may sound crazy to think that our brains have a new layer, but it’s not a bad way to think about the kind of world the Web is making.

We will need to understand more about the effects of the Web on our brains, on our attention and our ability to feel fully alive between the sliver of light between birth and death that was entrusted to us.

THE NEVER-ENDING STREAM

When was the last time you felt the beating of your heart? The breath in and out of your chest? The sound of rain falling on leaf-mush?

Do you know why you’re on Twitter? How long you’re on Twitter?

The Art of the Tweet – if there is one – is this: using the medium to learn something about our world and sharing your unique view of it with us mindfully. Life without mindfulness is a life lost. Twitter may increase your awareness of the world around you but only your mind supplies your life with meaning. How are you  maintaining your mind?

Tweets are like raindrops falling into a stream. So are the moments of your life. Are you paying  attention, or something more expensive?

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Healthcare’s Google-Facebook-Twitter Platform

Image representing Facebook as depicted in Cru...
Image via CrunchBase

Can’t we just have one place on the web where all of us around the world can congregate to acquire reliable health care content, connect patients with each other, have conversations, trade experiences and otherwise partake in the vastness of health care?

That certainly is a dream – an idea which many patients and families and professionals ponder. After all, Google, Facebook and Twitter respectively demonstrate the power of Search, Social Media and Real-time Connection to accomplish a whole host of objectives. What if we had a health care version of such a triad, unified into one platform? Is it do-able? Or, perhaps more importantly, is it necessary?

A GINORMOUS WEB WITH NO CENTER

As tempting as it may be to have a mega health care social platform, I think such a hope is wrecked by the reality of the Web. The Web is an ever-expanding confluence of machines and people and protocols and media. Like a consciousness, it has no Center, no single brain cell that we can point to and say Here it is, the center of our mind! And yet, like a consciousness, it produces the seamless experiences of awareness and connection and action which we view through our browsers and mobile devices and wherever else the Web infiltrates.

Perhaps the very model for any Web platform for health care communities of content and people lies right in the artful sciences beneath health care itself: the evolutionary underpinnings of networks of the tiny cellular gadgets that supply our lives. Yes, our bodies do have central nervous systems, but life owes itself to the vastly distributed cascading of events which aren’t necessarily centrally-controlled. That is, after all, the wonder and power of our universe’s serendipity. The web of life may be metaphor for the web we started spinning years ago.

So I wonder if our primary challenge in weaving a Health Care Web is understanding the nature of evolutionary systems. That perhaps we need to overcome our linear and strict architectural ways of thinking and building, and seek organic views of the Web.

Historically, in our efforts to wage war against dangerous bacteria and viruses, we have taken a decidedly mechanical approach: discover a vulnerability and attack it. It works, for a time. But then subtle mutations succeed and replicate and the vulnerabilities of our tiny enemies become strengths and we start to lose the war again.

So just as we may need radically different approaches to infectious diseases – approaches which advance natural processes versus stemming them – so too may we need a radical re-think in how we work with the Web. Rather than hoping to overlay a single giant complex that dominates the landscape like a Big Mother, we aught to consider the power of local networks and communities, learn to harness de-centralization and discover how to cull order out of chaos.

In many regards, we already are doing these things. Those of us who use media like Twitter have learned to appreciate the value of curation and we’re always seeking out and playing with toys which help us streamline and enhance our consumption and production of information. Patients seeking health-related content or community similarly need ways of finding the right channels.

Perhaps, then, a key feature of health care online is providing media which improve the skills of patients in how to best derive order of out of chaos and separate verifiable fact from dangerous idiocy. How to accomplish such feats? One way is through individual, localized efforts on the part of patients, providers, technologists, librarians, entrepreneurs – charged with large boluses of initiative and courage.

ALL HEALTH CARE IS LOCAL

What we may need at the large scale isn’t a giant Google-Facebook-Twitter mashup for healthcare. Maybe what we need are media and tools which connect social graphs of people and databases and communities; which enable face-to-face communities which can be weaved back into the Web; which give permissions to patients and family members to port their data however they see fit; which enable providers to be bright facets at the critical nodes of key connections; which integrate emerging technologies and re-mash them into usable interfaces for expedient and curated information.

The fact about online health care communities is that they are, well, communities. Which is to say that their success depends on the particular dynamics and values of the communities. A service which offers forums for different health-related topics may house an amazing Diabetes group but fall short on Schizophrenia. Furthermore, patients and family members experience illnesses in their own unique ways: what may be a great community for someone with breast cancer may be ineffective (or even dangerous) for another.

We have many ways to go with the Health Care Web. We can’t necessarily busy ourselves with one silver bullet. So I offer one tip to the general public: advocate for change at the local level, using public social media to inspire passionate tribes of talented change agents. We can do that much now, without having to wait for the FDA or some other governmental agency to figure out how to hit the update button on Twitter, let alone how to piece together a Health Care Web.

If we can’t get our own family physician to connect with us on just one social medium, how can we connect the multitude of patients and providers globally?

What do you think? Is a Google-Facebook-Twitter Platform of Health Care achievable? Is it even necessary? Perhaps most importantly: is it something we should even desire, or fear?

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Twitter Lists Are Here to Stay – Deal With It

Listorious: Socialmedia Twitter List by See-mi...
Image by See-ming Lee 李思明 SML via Flickr

Twitter Lists! Twitter Lists! Twitter Lists! It’s all we hear about on Twitter and blogs about Twitter and tweets about the blogs about Twitter Lists. It’s nuts. Yes, I’ve been playing around with the new shiny feature too. Why not? I’m nuts myself about Twitter but I have my own reasons for that. So what’s the big fuss? Robert Scoble loves ‘em. Chris Brogan…not so much. (I’m largely with Scoble, but I understand where Brogan’s coming from.)

There are different ways to view Twitter Lists:

  1. They’re ego-expanding
  2. They’re ego-shriviling
  3. They’re exclusionary
  4. They’re inclusionary
  5. They’re meta-data
  6. They’re organizational tools
  7. They’re networking media
  8. They’re wet dreams for spammers
  9. They’re relational databases.

It’s not always easy to see the ramifications of what appear to be minor technological changes. Twitter itself exemplifies this principle: just as the invention of zero or the wheel appeared inconsequential at first, entire new branches of mathematics and economies realed out of them. A wheel is just a round thing – but soon applications built around that shape led to radically fundamental shifts in technological upheaval. Now think of Twitter’s API. The automobile is the result of the wheel’s API. Human imagination is the ultimate API.

So too with Twitter Lists, the consequences at first are hard to envision. Lists expand the reach of Twitter’s extensive Web. Twitter is a Web on to itself: a metaphorical protocol of people-to-people connectivity, as fundamental as TCP/IP. Soon machines will be tweeting each other. Let your imagination streach on that one. No less with Lists: we will see them used in ways Twitter, Inc. never considred.

Now you can follow Lists – entire ecosystems – just as you could follow individual accounts. In addition to following the Individual, you can now follow the Collective. With Twitter’s API, we can now add context and curation to Lists – just as services like Twazzup contextualize individual tweets, new services could do the same for Lists. In addition to What does the public think of Twitter Lists, for example, we could ask What do tech bloggers or venture capitalists or journalists think of Twitter Lists.

Depending on the events of our childhood, Twitter Lists will appeal and wound our egos. That’s OK – if you’re hurt a little by being exluded from the cool kids table, you’re human. But look past what Twitter Lists can do for the social web and figure out your own way to keep the Web as human and useful as possible.

For as much as we welcome or curse Twitter Lists, they are here to stay – one way or another. They will help and enable people to connect in new ways. They’ll hurt people too. We can hope that Twitter, Inc. will appreciate the powers of this tiny addition to their service such as permissions, but I wouldn’t count on it. Whatever Twitter does or doesn’t  and however Lists evolve, we’re all just going to have to deal with whatever comes our way.

May the Goddesses help us.

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