Closing keynote, Health Innovation and Policy Summit, Toronto ( http://www.webcitation.org/5WF2RuqK4 ), on May 1st, 2008, on web 2.0 in health

1. Associate Professor Department of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist , Centre for Global eHealth Innovation, Division of Medical Decision Making and Health Care Research; Toronto General Research Institute of the UHN, Toronto General Hospital, Canada Patient Portals and Web 2.0 – The Next Wave on the Web and Impact on Patient Driven Care Gunther Eysenbach MD MPH Gunther Eysenbach MD MPH

2. (cited by: Pablo Rivero’s presentation)

3. “ the doctor is not an expert in the experience of illness, but in the identification of it “ . Davidson KP, Pennebaker JW. Virtual narratives: Illness representations in on-line support groups. In: Petrie KJ, Weinman JA, editors. Perceptions of Health and Illness. Amsterdam: Harwood Academic Publishers; 1997. p. 463-86 Building social patient networks on the Web

4. Traditional hospital-based health care system Obesity

5. Copyright ©2006 BMJ Publishing Group Ltd. Thun, M. J et al. Tob Control 2006;15:345-347 http://tobaccocontrol.bmj.com/cgi/content/full/15/5/345 Between 1991-2003, cancer mortality decreased by 12% 40% of this decrease is attributed to smoking cessation The importance of behavior change and prevention…

6. eHealth can support behavior change and prevention

8. Eysenbach G: Consumer health informatics. BMJ 2000;320:1713-16 Healthcare 1.0 Healthcare 2.0

9. http://en.wikipedia.org/wiki/Image:Web20_en.png

10. Source: http://web2.wsj2.com/

11. Social Networks Connect Users into Communities of Trust (or interests)

12. ...A Bubble? A Bubble? ...A bubble? ...A Bubble? ...A Bubble? ...A Bubble? ...A Bubble? ...A Bubble? Photo courtesy of brokenchopstick

13. “ Web 2.0 is a meaningless buzzword used by Starbucks-slurping cretins.” “ Ilyag”, http://digg.com/tech_news/10_definitions_of_Web_2_0

17. Web 2.0 = Culmination of Converging Trends Technical Business Social Web 2.0

22. JMIR “Medicine 2.0” Special Theme Issue (and Congress) www.jmir.org

23. www.medicine20congress.com , Toronto, Sept 4-5 th , 2008

24. Medicine 2.0 (“next generation medicine”) Full paper will appear as: Gunther Eysenbach. Medicine 2.0. J Med Internet Res 2008 (in press) http://dx.doi.org/ 10.2196/jmir.1030 DOI: 10.2196/jmir.1030 Consumer / Patient Health Professionals Biomedical Researchers Science 2.0 Peer-review 2.0 Personal Health Record 2.0 Virtual Communities (peer-to-peer) Professional Communities (peer-to-peer) Health 2.0 HealthVault Google Health HealthBook Sermo WebCite CiteULike MDPIXX WiserWiki eDoctr BioWizard Dissect Medicine E-learning PLoS One BMC JMIR Wikis Blogs RSS RDF, Semantic Web Virtual Worlds Web 2.0 Technologies & Approaches Apomediation Participation Social Networking Collaboration XML AJAX Openess Revolution Health PatientsLikeMe PeerClip Connotea ALIVE HealthMap caBIG

25. Patient Portals and “PHR 2.0”

30. Blood Pressure - Chart Source: Jay Mercer

32. EMR “ Tethered” PHR/ PAEHR “ stand-alone” PHR PHR EMR Read only Read+Write/Annotate PHR PHR © Gunther Eysenbach, CC-BY

33. EMR EMR PHR Different providers “ interconnected” PHR © Gunther Eysenbach, CC-BY PHR PHR

34. Records at Financial institutions Personal Finance Records © Gunther Eysenbach, CC-BY

35. Tang et al, JAMIA 2006

36. EMR EMR PHR Different providers Health Information is tightly protected © Gunther Eysenbach, CC-BY PHR PHR

37. What these models neglect: People want to SHARE some of their personal information Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists J Med Internet Res 2007;9(2):e12 <URL: http://www.jmir.org/2007/2/e12/>

38. Another example for sharing personal health information

39. EMR EMR PHR PHR PHR Different providers PHR 2.0 © Gunther Eysenbach, CC-BY Community Other peoples’ PHR Other peoples’ PHR Other peoples’ PHR

41. Will social networking provide additional mechanisms and incentives for people to manage their own health (and health information)? http://www.competeinc.com/news_events/pressReleases/168/ http://www.webcitation.org/5VuPjJxo5

42. Conclusions: Implications for eHealth and Health Policy

43. What does this all mean for health care / eHealth (1) ? “ [People from the] Google Generation are impatient and have zero tolerance for delay, information and entertainment needs must be fulfilled immediately ( e.g. Johnson, 2006: Shih and Allen 2006)” Information Behaviour of the Researcher of the Future – The Literature on Young People and Their Information Behavior URL:http://www.ucl.ac.uk/slais/research/ciber/downloads/GG%20Work%20Package%20II.pdf. Accessed: 2008-04-09. (Archived by WebCite ® at http://www.webcitation.org/5WxqwuH4g)

46. Patient data External evidence General health information Personal health information Literature Mass Media Internet Health Record Relevant +credible Information Patient Patient accessible electronic health records Medical knowledge Disintermediation / Apomediation Physician (health professionals, librarians) as intermediary Irrelevant inaccurate Irrelevant Information “ Apomediaries”

48. Knowledge Self-efficacy Autonomy Empowerment - decreased reliance on experts Apomediation replacing the intermediary Success Failure Intermediary reliance on authorities/ experts Gunther Eysenbach. Credibility of Health Information and Digital Media: New Perspectives and Implications for Youth. In: Miriam J. Metzger & Andrew J. Flanagin (eds.). Digital Media, Youth, and Credibility. MacArthur Foundation Series on Digital Media and Learning. MIT Press 2007 www.mitpressjournals.org/doi/pdf/10.1162/dmal.9780262562324.123 Dynamic Intermediation/Disintermediation/Apomediation (DIDA) Model (Eysenbach, 2007)

50. www.medicine20congress.com , Toronto, Sept 4-5 th , 2008

51. Thank you! Dr G. Eysenbach, Email: geysenba@uhnres.utoronto.ca, Personal Homepage: http://yi.com/ey/