Resilient Ambassadors of Change

Disclaimer: This Post Has Not Been Fact-Checked

I was introduced to social media and civic journalism guru Jay Rosen's blog today, and stumbled upon what I felt was a fascinating post summarizing the major points of the journalists vs. bloggers debate.  Of course, the post was written in defense of bloggers, but nevertheless it highlighted some of the key issues, one of which is the tension between "traditional" journalism and blogging. 

Rosen's summary is far better than anything I could write, so I suggest taking at least a cursory scan - but essentially the gist is that journalism holds in high regard its role as an "objective" source of "primary source verified" information, and really, blogging flies in the face of all that.  Blogs are transparent, updated quickly and (hopefully) often, participatory, messy and subjective.  While most serious bloggers certainly avoid mistakes, I believe the value does not emerge from the original post, but from the social processes surrounding it - the open debate, the longitudinal (time) and latitudinal (blogs) tracking of post "topics", the cross-blog engagement, the public empowerment.  What eventually emerges from this process is a picture of the topic - there really is no striving for "100% truth."  This news format threatens journalism as it has been practiced at least the past three decades.  The average citizen now (theoretically) has access to the same information as the journalist, and has the ability to publish anything with (theoretically) the same audience penetration, and it's ok if they make mistakes.  I can just hear the hoardes of journalists now:  "You mean I've been sending my articles through the cubicle gauntlet of fact-checkers all this time, and now anyone can post anything online and it's considered news?  Puh-LEEZ."

Now, for the real question: What effect will this have on innovative assessment across the med ed:practice continuum?

Is increased regulation in the Internet's future?

I was tempted to answer the question posed in the subject line with a simple, definitive "yes", but I realized I should probably elaborate a bit - after all, "yes" isn't much of a blog post. 

  The concept of identity has been intimately linked to the Internet since its beginnings - after all, computers have identities, users have identities, and all have to be managed as part of the Web.  We choose usernames and passwords and use them to manage our online identities; but a lack of a pervasive standardized identity management system like Microsoft's .net software (a la Identity 2.0) enables users to hide behind a layer of anonymity.  MrKewlD00D22 isn't afraid to speak his mind on the discussion board of his favorite science magazine, even if he is painfully shy in person.  PunkRockGrrl87 and MackDaddy00 chat online each day, but their real-life counterparts have never met.

However, as the lines between reality and virtual reality become more blurry, it seems identity is more of a sticky situation. Take for example the recent, very unfortunate story of a mother pretending to be a teenage boy on Myspace for the sole purpose of harassing one of her daughter's female classmates, which ultimately ended in the 13-year-old girl's suicide.  The mother had been facing up to 20 years in prison for conspiracy charges, but the conspiracy charges were thrown out and she now faces 1 year in jail and $300,000 fines for 3 misdemeanors.  This situation brings to light all sorts of regulatory issues around the Internet. For example, if one is to be held personally accountable to the Terms of Service on a site, then somehow their online identity must contain meaning that links to their real life.  And how many "teeth" do the Terms of Service have in terms of the law?  Do the same rules apply online as they do in real life? 

These are important questions, and are becoming even more important as future generations engage with and build upon the giant information monstrodome that is the Internet.  Frankly, I think the time for more regulation with regard to identity (and information veracity) is far past its due date.

Now Presenting...Some News of Interest

Google opened its EHR to the public on Monday. Thus far Walgreens, CVS, the American Heart Association, Quest Diagnostics, Beth Israel Deaconess Medical Center and the Cleveland Clinic are all plugged in to share data. Google's EHR also enables you to enter a list of meds, and alerts you of possible drug interactions. I think it has potential. (Check out the New York Times article for more info.)

We've been keeping tabs on the world of physician ratings, which seems to be exploding right now. Patients don't have much data on doctors, and so they want to know what other patients think. Some doctors question the accuracy of data and the possibility of misinterpreting the data (e.g., if there aren't enough raters, if some patients only choose to "rate" when they are angry so the results are negatively skewed,etc.) A recent article in the LA Times gives a good overview of the rating sites available and some of the debate. I was interested to see there was a site where nurses rate doctors.

Other stuff:

Doctors Say 'I'm Sorry' Before 'See You in Court'
New Sites Make It Easier To Spy on Your Friends
Disney is going to build a biometrics lab to measure responses to advertisements (YIKES)
Web 2.0 Can Give Consumers More Control over Health Care

Pioneer of patient-centered care, dead at 92

Harvey Picker, founder of the Picker Institute is remembered in a New York Times article.  He is credited with coining the term "patient-centered care."

"In 1986, after witnessing the care that his wife, Jean, was receiving for an incurable infection of the head and neck, Mr. Picker created the Picker Institute. A nonprofit organization, with headquarters in Boston, it conducts research on how the medical community can improve the experience of patients, beyond meeting their specific health needs."

This article led me to the Picker Institute web page, which might be a good place to explore grant opportunities and survey tools designed for collecting information about physicians.

If current trends are any indication of the future

...then patients will have information on their doctors and hospitals, and it may be as easy to access as a search engine. Robots will be delivering drugs in hospitals and a doctor will just have to talk to her/his patient to have data added to an electronic medical record using voice-recognition software. The problem of how to use a computer to process unstructured data may still plague mankind, but the burden may be lessened as the user population adapts to the interfaces, thereby creating a lesser amount of unstructured data. And we may know more about why we should trust our gut in some situations.

I'm not counting on that last one, though.

The Science Of Sleep

This article is about the science of sleeping. It is a long read but what happens when we are sleeping and the growing studies behind dreams interests me a lot. If we can learn more about how dreams work, maybe we can apply "The Science of Sleep" to truly suspending disbelief in simulation environments.

http://www.cbsnews.com/stories/2008/03/14/60minutes/main3939721.shtml

New York City to launch patient-tracking system

The Mayor of NYC has announced that soon, the city will supply doctors with software to track patients' medical care.  The system will be open-source, and will integrate a patient's medical info, alert doctors of health issuees, and allow data-sharing among healthcare professionals.  It's unclear to me from the article whether this software is a more dynamic EHR which may or may not always be "on the person", or whether it actually includes wireless technology for near real-time data-sharing.  It will be interesting to watch this one unfold.  The New York Times (2/26)

Federal judge orders Web site shut down

Jeffrey S. White, a U.S. District Court judge in San Francisco, ordered the site Wikileaks.org shuttered for disclosing proprietary and confidential information, setting the stage for a First Amendment showdown regarding the rights of Web publishers. The site still is operational through its numerical IP address and through mirror sites hosted abroad. The judicial order merely required domain host Dynadot to disable the site name. The New York Times (2/20)

Why is this important?  Well, it has implications for Net Neutrality, and Net Neutrality has huge implications for the future of the Internet.  And this is all part of the big bubble of "general issues related to public information", such as privacy, security, confidentiality, ethics, transparency, identity and access, which affects us all (yes, even those of you without a computer could be affected, because data about you is out there!)