A9BakerHoehlMeyers

A9BakerHoehlMeyers

To Do

• 1. please work as a group (minimum: 2 members; max: 6 members) and submit one answer as a group (clearly identifying the members of your group)
• 2. Read:
  • Chapter 8 in Ben Shneiderman's book entitled "The New Medicine: E-Healthcare" (lecture on Oct 27)
  • Chapter 9 in Ben Shneiderman's book entitled "The New Politics: E-Government" (lecture on Oct 29)

Question 1

discuss what YOU consider the two major influences of information and computer technology on healthcare with comments on how these developments have changed:

• the healthcare business
• the doctor/ patient relationship (pluses and minuses)

Question 2

assume you need to inform yourself about some medical problem or issue (e.g.: high blood pressure, hip surgery, torn ACL or Achilles tendon, obsessive compulsive disorder (OCD), attention deficit disorder (ADD), you want to travel to a country in Africa (any precautions needed?), ....) - choose one example from the list or one chosen by yourself and

• explore the WWW about it, and
• describe what you found out and did not find out?

Question 3

as elections are coming up on November 4, 2008:

• identify the major differences between elections in 1980 (before the Internet, Social Networking, blogs, ....existed) and 2008!
• which new possibilities do you personally see as positive or negative developments?

Group response

1. Members of the Group

Chris Baker, Jeff Hoehl, Jane Meyers

2. Question 1

The emergence of EMR's , Electronic Medical Records, and the dissemination of authoritative medical information online have or stand to revolutionize our healthcare system. Converting a patients paper files to a portable medium will undoubtedly threaten healthcare businesses by facilitating a patient's ability to switch providers, while simultaneously reducing redundant work, duplications of expensive tests, and providing more accurate and complete patient histories. EMR's may also cause medical professionals to careful in how they annotate files, as their notes will be reviewable not only by patients but future healthcare professionals. EMR could also be used to link family profiles to provide extensive and accurate information about genetic preconditions and histories. Additionally, if EMR's include the capability for patient annotation, medical professionals may have an even richer and detailed information base. Of course, all of these changes assume that increasing the amount of information provided to healthcare professionals will ultimately increase the quality of patient care. If medical providers are unable to sift through this information overload to identify the crucial facts, would the quality of patient care ultimately suffer?

Access to medical information online, whether from credible or incredible sources, stands to both strain and strengthen doctor/patient relationships. Even inaccurate information stands to empower patients, causing them to feel more confident in their understanding and more likely to ask questions. This influx of information could render patients more knowledgeable and thus more capable of communicating with their doctors and/or it could lead patient's to question the accuracy of their doctor. Like Ben Shneiderman states, increased access to health information stands to strain relationships with medical professionals who are uncomfortable or not used to patients questioning their authority. If technologies are developed with the capability to diagnose medical conditions, this may effect the healthcare business. Although for all relatively severe health problems, patients will ultimately need to communicate with medical professionals if they want any type of prescription medication. Unless this changes, the healthcare business will not be entirely threatened by the dissemination of medical information online.

3. Question 2

Medical practice is currently undergoing a destabilizing transition caused by the wealth of information available to patients via the internet. The power balance between patient and doctor is being renegotiated. As a patient this is an exciting prospect. Perhaps we will no longer view doctors as wizards wielding unfathomable power to cure what ails us, and we can begin to understand how our bodies work and how ills are treated. But it is quite easy to take this too far. There is a good reason why it takes such an enormous amount of schooling to be allowed to practice medicine.

The weakness in "doctor-free" medicine becomes obvious when we try to find resources on a common problem such as insomnia. A Google search on this topic yields such an enormous amount of information it is hard to know where to start. Causes range from stress, anxiety, drugs, problems with your karma, hormones, evil spirits, and genetic preconditions. Treatments are even more varied, including a wide range of medications, therapy, breathing exercises, herbal remedies, aromatherapy, and acupuncture. There are recommendations for how to change your lifestyle, how and when to exercise, foods to avoid, even ways to rearrange your sleeping quarters.

With all this competing information, what are we to do? An obvious limitation to the web search I performed is that it is not sensitive to the complexities of my unique situation. A doctor knows what questions to ask about my lifestyle to narrow down a probable cause. A doctor is also aware of what remedies have been clinically proven to work (although proponents of alternative medicines will claim there is a bias here). Even more importantly, a doctor is outfitted with expensive medical equipment I could never hope to acquire or learn to use myself. A "simple" blood test can be quite informative.

What will medical practice look like once this situation stabilizes? It's hard to tell, but I have anecdotal evidence that a hybrid between a traditional doctor/patient relationship and "doctor-free" medicine can be beneficial for everyone involved. A few years ago my grandfather, an quite healthy man in his 70s, was very suddenly struck with a mysterious condition that left him virtually unable to move. The doctors were baffled as all the tests they performed came back negative. It was a quite scary situation as his condition continued to get worse and nobody had a clue what was happening. As he was in the hospital undergoing tests, several members of my family were scouring the internet to find some clue what was happening. In her searches my grandmother read about Guillain-Barré syndrome (GBS), a very rare autoimmune disease that results in a rapid deterioration of the peripheral nervous system. She presented her findings to his doctors who eventually diagnosed him with GBS. Because of successful diagnosis they were able to treat him to a full recovery and he now shows no signs that the event even happened.

I think this story is a good model for how the doctor/patient relationship could be revised in the future. Everyone was thankful for his recovery and his doctors learned about a disease they had never encountered before. At no point was there a sense that my grandmother had overstepped her bounds and infringed upon the doctors' territory. She was respectful of their extensive medical training, and they were humble enough to know that they could not possibly be familiar with the entire extent of medical knowledge.

4. Question 3

Much about the political climate in 1980 is similar to that of the current election; however, the general information and communication infrastructures have expanded greatly. The Internet and digital communications not only provide many more forms of media, but allow the preservation and recollection of the information collected. For example, relatively new forms of information such as wikis, blogs, forums, picture-sharing, and video sharing not only distribute content to the public, but do so in an asynchronous manner. As such, the information is preserved and always accessible and reviewable. More importantly, the information is easily shareable. A user can distribute a video clip or a news article to many friends quickly and easily. This contrasts greatly with the early eighties in which information was largely distributed via television, radio, and newspaper. Though one could share this information it was physically based and not easily reproducible or easily retrieved from archives. Furthermore, television, radio, and newspapers provide a predominantly one-way dissemination of information. Journalists and editors create content and distribute it to a public within regional restrictions. The Internet has created a conduit for smaller organizations and non-professionals to disseminate opinions and thoughts cheaply and easily and without regional borders. It has also allowed small and large organizations to advertise to target-specific and context-sensitive ads thus specifically communicating to certain demographics. Furthermore, many large news organizations have enabled public commenting and criticism of articles. In essence, the Internet has increased the amount of bi-directional communication between content producers and content consumers and also created a larger set of content producer/consumers.

The modern communication infrastructures have provided several positive benefits to political awareness, research, and discussion. First, citizens have easy access to a larger breadth of stories, opinions, and explanations of political viewpoints. This not only encompasses candidates but discussion for and against local propositions and amendments, which can often be misleading or confusing. Users can also more easily retrieve world opinions or see impacts across the globe that regional newspapers or television stations would have likely neglected. Thus, voters are able to thoroughly research and obtain background information on political positions to make well informed and analyzed choices. Second, users can express their opinions in a larger number of ways and spread specific messages. Although many people still elect to use bumper stickers and yard signs to designate their opinions, Facebook, MySpace, and YouTube have become staples in stating opinion and sharing ideas with friends, families, and social communities. More importantly, specific ideas can be shared and spread with links or references to easily obtain more information. Friends and social communities have taken well to spreading humorous clips of interviews, satires, or criticisms on television that would not have easily been shared three decades ago. Third, better archiving and retrieving of material has led to better statistics and more poignant political commentary on previous speeches, voting records, spending habits, and general political behavior. Candidates and users alike can easily retrieve old records and use them to show idiosyncrasies or hypocrisies in behavior. Lastly, the Internet and cheap communication has allowed more diminutive groups to gain exposure and express their ideals and messages. Third party candidates and independent nominees are more easily able to reach voters that may agree with them using the Internet. For example, the Wikipedia entry on the 2008 elections shows several third-party and independent candidates along with the two primary candidates (1).

Although the Internet and digital communication can provide many benefits, there are many strong downsides to online politics. First, voting behavior has not radically changed even with the use of the Internet (2). Rather, individuals use the new forms of media to seek others that think like them and reinforce their opinions rather than looking to change their opinion or vote based on values. Voting still remains predominantly based on party affiliation and not personal values. Thus, the Internet has facilitated a general polarization of attitudes rather than a radical shift in attitudes themselves (2). Second, the deluge of information from the Internet can be confusing and disoriented and is often purposefully created as such. It is often difficult to ascertain the accuracy, journalistic integrity, or reputability of information producers over new forms of media. Thus, misinformation can and does easily spread and reaches a much wider audience. Third, consumer-created content does not have the same journalistic or editorial integrity that many professional organizations try to uphold. Rumors and slanderous stories are often spread and can detract from focusing on important issues and resolutions. A push for faster information dissemination can often lead to a lack of fact checking which further instigates the spread of misinformed stories and rumors. Lastly, the constant archiving of information has led to a large culture of sharing and distributing mistakes of candidates. Thus small mistakes in speech, intent, or historical performance can easily be exaggerated or highlighted. In short, the Internet has provided a much wider range of technological capability, but has not changed traditional human behavior in politics.

References

1. United States presidential election, 2008. October 2008. Wikipedia. Available online at http://en.wikipedia.org/wiki/2008_Presidential_Election

2. Cornfield, M., Rainie, L. 2006. The Impact of the Internet on Politics. Pew Internet and American Life Project. Available online at http://www.pewinternet.org/ppt/PIP_Internet_and_Politics.pdf