Using internet and web technology for clinical purposes: what has been tried and evaluated; what works and what needs more work; words of caution; coming shortly - but not yet fully evaluated for clinical applications.

1. UpToDate and beyond
The internet and patient care

9. “Behind the headlines from NHS Choices”
http://www.nhs.uk/news/Pages/NewsArticles.aspx

10. Some tools
• Webinars
• Online conferencing
• Podcasts
• YouTube: patient information and CPD
• SlideShare
• MOOCs (Massive Open Online Courses)

13. Virtual MDTs – will they work?

15. www.mooc-list.com
https://www.edx.org/

18. Social media ban - exceptions needed

21. Clinical uses/opportunities
• Patient/clinician education and information
• Remote monitoring of chronic conditions
• Patient and family/care-giver support
• Post-discharge psychosocial support
• The Electronic Health Record
• Online collaboration
• Guides to everything

22. From:
BMC Res Notes. 2012; 5: 548.
Published online 2012
October 3.
doi: 10.1186/1756-0500-5-
548
Design and process
evaluation of an informative
website tailored to breast
cancer survivors’ and
intimate partners’ post-
treatment care needs
Evelyn Pauwels,1 Elke Van Hoof,2,3
Caroline Charlier,1,4 Lilian Lechner,4 and
Ilse De Bourdeaudhuij

24. BMC Dermatol. 2011 May 18;11:10. doi: 10.1186BMC Dermatol. 2011 May 18;11:10.
doi: 10.1186/1471-5945-11-10.
Mapping randomized controlled trials of treatments for eczema--the GREAT
database (the Global Resource of EczemA Trials: a collection of key data on
randomized controlled trials of treatments for eczema from 2000 to 2010).
Nankervis H, Maplethorpe A, Williams HC.
“An international, publically available and comprehensive
resource which brings together all randomized controlled trials
on eczema treatment using a highly sensitive search has the
potential to release more filtered knowledge about patient
care to those who need it most and to significantly shorten the
duration and costs of many clinical eczema research and
guideline projects……
The database can be accessed free of charge at
http://www.greatdatabase.org.uk .”

28. Considerations
Recognise limitations:
• Demographics – potential user profiles
• Information in context
• Ability to interpret information
• Ability to appraise information
• “incomplete and impersonal”
Need for selection and direction

29. http://blog.tutorspree.com/post/54349646327/death-of-organic-search
Roughly 13% of your screen will display actual results; the rest will be
taken over by ads and other unsolicited activity.

30. Untangling the Web — Patients, Doctors, and the Internet
Pamela Hartzband, M.D., and Jerome Groopman, M.D.
N Engl J Med 2010; 362:1063-1066
March 25, 2010DOI: 10.1056/NEJMp0911938
“The benefits, though, must be weighed
against the potential negative effects of
receiving clinical data without context. Patients
and families may be confused by results and
worried that minor abnormalities might
portend serious consequences.”

31. Conclusion: The study demonstrates that online counseling
via e-mail reaches patients with unmet therapeutic
needs, but also indicated its limitations, suggesting that the
online setting may be most useful for prompting and
supporting a transition to conventional counseling
services.
Psycho-Social Medicine
January 1 2011 | Volume 8 | ppg Doc05
doi: 10.3205/psm000074
Online counseling via e-mail for breast cancer patients on the German
internet: preliminary results of a psychoeducational intervention.
David N, Schlenker P, Prudlo U, Larbig W

32. http://blogs.biomedcentral.com/blog/2013/08/12/a-call-to-
action-from-alltrials/

33. The Western Journal of Emergency Medicine
November 1 2011 | Volume 12 | Issue 4 | ppg 442-7
doi: 10.5811/westjem.2010.9.1895
Can emergency medicine residents reliably use the internet to answer clinical questions?
Krause R, Moscati R, Halpern S, Schwartz DG, Abbas J

34. SVHG Clinical Information Portal
A single entry point for communication and
access to all clinical information required for
patient care in SVHG.
Current discussions with Pharmacy and ICT.

35. Mobile/tablet uses

36. CONCLUSIONS: While the smartphone's role in medicine
and education appears promising and exciting, more
high-quality studies are needed to better understand the
role it will have in this field. We recommend popular
smartphone applications for physicians that are lacking in
evidence and discuss future studies to support their use.
Journal of Medical Internet Research
January 1 2012 | Volume 14 | Issue 5 | ppg e128
The smartphone in medicine: a review of current and potential use among
physicians and students.
Ozdalga E, Ozdalga A, Ahuja N

37. http://www.docphin.com/

38. The future?

40. Cloud computing
“… application would allow workers to log into a
Web-based service which hosts all the programs
the user would need for his or her job. Remote
machines owned by another company would
run everything from e-mail to word processing
to complex data analysis programs.”
http://www.howstuffworks.com/cloud-computing/cloud-computing.htm

41. http://www.youtube.com/watch?v=A7G3gzdLDcQ

42. http://www.kevinmd.com/blog/
2013/08/fix-google-maps-
patients-start-dying.html
You may not have asked to be
added to Google maps, but
it’s up to you to try to correct
it. And this isn’t easy.

45. Harnessing the cloud of patient experience: using social media to detect poor quality
healthcare
Felix Greaves, Daniel Ramirez-Cano, Christopher Millett, Ara Darzi, Liam Donaldson
BMJ Qual Saf 2013;22:3 251-255 Published Online First: 24 January 2013
doi:10.1136/bmjqs-2012-001527
BMJ Qual Saf doi:10.1136/bmjqs-2012-001744
Editorial: Patient-centred healthcare, social media and the internet: the perfect storm?
Ronen Rozenblum, David W Bates
“In the past, healthcare was managed mainly via interpersonal communication between
the caregiver and the patient, while today, social media offers different modes of
interaction. For example, Facebook has become a significant source of healthcare
information, such as specific data about health conditions and healthcare facilities,15
and blogs have become a powerful communication tool to disseminate health
information and engage patients with their care. Researchers have found that, based on
the data posted on Twitter, they can detect an array of types of activity, most notably
disease outbreaks such as cholera and influenza,16 ,17 but more recently, data about
issues like headache appearance.18”
http://qualitysafety.bmj.com/content/early/2013/01/31/bmjqs-2012-001744.full

47. Big Data:
http://www.autonomy.com/content/Technology/what-is-big-data/index.en.html

48. Online privacy
• Earlier this year a Harvard professor was able to re-identify
individuals in a genetics database by cross referencing with public
records, with an accuracy rate of 42% if only three types of
information - zip code, date of birth and gender - were
present, rising to 97% when first name or nickname - information
that could easily be extracted from many email addresses - was
added.
Data security and privacy: can we have both? Companies store copies
of information in multiple locations to minimise the risk of data
loss, but does our right to privacy suffer as a result?
Email : John Burn-Murdoch; theguardian.com, Wednesday 31 July
2013 07.30 BST

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