May 31, 12:00:07 PDT> *enochchoi*: I'm here...

May 31, 12:00:32 PDT> *Alex*: Great!

May 31, 12:00:47 PDT> *Alex*: I'm not sure whether Emily was able to join us

May 31, 12:00:54 PDT> *Alex*: ok, maybe not

May 31, 12:01:05 PDT> *Alex*: there she is!

May 31, 12:01:06 PDT> *enochchoi*: Nice to take a break from seeing
patients here ;)

May 31, 12:01:09 PDT> *Emily*: Hi

May 31, 12:01:17 PDT> *Emily*: I was refreshing the chat window, sorry

May 31, 12:01:30 PDT> *enochchoi*: Otherwise i'd be at the conference in
person, it's so close!

May 31, 12:02:48 PDT> *enochchoi*: I wanted to offer up this hour to
questions about how technologies are enabling patients to get healthier:

May 31, 12:02:48 PDT> *Emily*: there was a problem with the server

May 31, 12:02:50 PDT> *enochchoi*: personal health records

May 31, 12:03:07 PDT> *enochchoi*: reading blogs, listening to podcasts,

May 31, 12:03:20 PDT> *enochchoi*: participating in online community

May 31, 12:03:46 PDT> *enochchoi*: and emerging technologies such as
tagging, to help those searching for information to get better quality
results

May 31, 12:05:33 PDT> *enochchoi*: as well as mobile access to these
technologies

May 31, 12:05:47 PDT> *enochchoi*: (gee... i wonder if everyone's going
to lunch... ;)

May 31, 12:06:18 PDT> *CatSilvestre*: would it be possible to also
mention how technologies could be used to help researchers and
physicians (and thus help patients)?

May 31, 12:06:57 PDT> *enochchoi*: Certainly, this morning a collegue
commented they're lucky to finish their charting much less blog

May 31, 12:07:15 PDT> *enochchoi*: one way physicians are getting more
efficient is by communicating online

May 31, 12:07:30 PDT> *Emily*: I am sorry, I keep losing connection

May 31, 12:07:33 PDT> *jimjanm*: My question is not about patients as
"end-users" of technology, but rather how health-care non-profits can
make more effective use of technologies to access and exchange
best-practices information that will increase their capacity to serve
patients.

May 31, 12:08:26 PDT> *enochchoi*: Cat: my collegues at PAMF communicate
with 57,000 patients who use our personal health record, to answer
questions, refill prescriptions, make referrals

May 31, 12:08:32 PDT> *Emily*: that's a good question jimjanm

May 31, 12:08:36 PDT> *enochchoi*: and allow them to reivfew their past
visits

May 31, 12:08:41 PDT> *enochchoi*: it's more efficient

May 31, 12:08:56 PDT> *enochchoi*: My group is a non-profit

May 31, 12:09:18 PDT> *enochchoi*: and invests our profits into the
community doing free care (where i was yesterday morning)

May 31, 12:09:26 PDT> *enochchoi*: and technologies that help us work better

May 31, 12:09:54 PDT> *enochchoi*: one of these is the Electronic Health
Record that allows us to do everything we used to do via paper and
dication, online.

May 31, 12:10:17 PDT> *enochchoi*: That includes making orders,
prescriptions, referrals, communicating with patinets

May 31, 12:10:51 PDT> *John*: Healthcare technologies have mostly been
implemented top-down... any room where technologies can evolve bottom-up
into healthcare orgs?

May 31, 12:11:08 PDT> *Alex*: I have a related question to John's

May 31, 12:11:26 PDT> *enochchoi*: jimjanm: my collegues and I exchange
best-practice information within our group, and externally to Sutter health

May 31, 12:11:30 PDT> *Alex*: do you see web 2.0 tools like patient
blogs & listservs changing the fundamental model/power dynamics of
medical care?

May 31, 12:11:49 PDT> *Alex*: e.g. less deference to docs, more
patient-centered?

May 31, 12:13:26 PDT> *enochchoi*: john, alex: as far as patient's
willingness to be open with their experience in blogs and listservs, yes

May 31, 12:13:26 PDT> *enochchoi*: it's a powerful tool to review
professionals

May 31, 12:13:26 PDT> *enochchoi*: and share what worked for them

May 31, 12:13:26 PDT> *enochchoi*: and who provided that care

May 31, 12:13:30 PDT> *Emily*: do you think professionals are part of
these listservs or read these blogs?

May 31, 12:13:32 PDT> *enochchoi*: The problem lies though in areas with
less MDs, you may not want to post inflamatory comments about a doc if
they're the only one in town

May 31, 12:13:32 PDT> *Alex*: one thing I wonder about is what role
doctors and health-related ngos can play in addressing erratic quality
of info online

May 31, 12:13:37 PDT> *enochchoi*: emily: very few

May 31, 12:13:37 PDT> *Danielle*: How to persuade knowledge mavericks
(both patient and doctor) to participate in these forums, blogs,
list-servs, etc.?

May 31, 12:13:40 PDT> *CatSilvestre*: one very small thing we do at PLoS
Medicine is make our medical literature downloadable to pdas and other
handhelds

May 31, 12:13:42 PDT> *jimjanm*: Emily: absolutely. I had experience 4
yrs ago of a listserv related to an ear syndrome -- and most of the
doctors at the specialist clinic at which I was treated were subscribing!

May 31, 12:14:03 PDT> *Alex*: with more people relying on self-serve
health info online, I'm struck by how undiscriminating people often are
about what to believe -- and how hard it is to figure out who is behind
the info on a web site

May 31, 12:14:17 PDT> *enochchoi*: Alex: Google health co-op is the way
i'm helping with that

May 31, 12:14:25 PDT> *Alex*: do you have an URL?

May 31, 12:14:39 PDT> *enochchoi*: danielle: very difficult. MDs
self-select to what they're interested in

May 31, 12:14:51 PDT> *enochchoi*: Cat: great stuff at PLoS!

May 31, 12:15:19 PDT> *enochchoi*: jimjanm: probably not the norm for
many MDs to be online

May 31, 12:15:19 PDT> *John*: can you describe a little about Google Co-op?

May 31, 12:15:42 PDT> *enochchoi*: Alex: look for university
sponsorship, academic credentials

May 31, 12:15:42 PDT> *enochchoi*: Alex: http://www.enochchoi.com/thoughts/

May 31, 12:16:03 PDT> *CatSilvestre*: Thanks, but we'd like to do much
more. Hoping you can help inspire...

May 31, 12:16:04 PDT> *enochchoi*: Alex: also look for HON: health on
the net

May 31, 12:16:49 PDT> *enochchoi*: John: it's a way for physicians to
help categorize URLs that they trust into topics such as symptom,
treatment, side effect, age and sex

May 31, 12:17:21 PDT> *enochchoi*: John: if someone subscribes to you,
they can have their google results filtered to specifically that topic

May 31, 12:17:46 PDT> *enochchoi*: http://www.google.com/coop/

May 31, 12:17:46 PDT> *John*: thanks

May 31, 12:18:04 PDT> *CatSilvestre*: in your online health records, do
you do anything to provide patients with health information relevant to
them?

May 31, 12:18:09 PDT> *enochchoi*: John: anyone can participate, health
is just one topic

May 31, 12:19:21 PDT> *enochchoi*: John: when your tagging is determined
as reliable and meaningful by some machine algorithm, Google
incorporates it directly into Google Co-op health topic so that you
don't have to subscribe to that contributor's tagging, it comes default

May 31, 12:19:37 PDT> *enochchoi*: Cat: absolutely, we use a lot of
healthline feeds

May 31, 12:20:00 PDT> *enochchoi*: Cat: but mostly we use Healthwise

May 31, 12:20:01 PDT> *John*: So there is a reputation system built-in

May 31, 12:20:15 PDT> *enochchoi*: DISCLAIMER: i should have started out
with this statement:

May 31, 12:20:26 PDT> *enochchoi*: I am a partner at Palo Alto Medical
Foundation

May 31, 12:20:35 PDT> *enochchoi*: a non-profit medical clinic

May 31, 12:20:48 PDT> *enochchoi*: I am a paid consultant to EPIC, OQO,
Healthline

May 31, 12:21:04 PDT> *enochchoi*: I am an unpaid participant with
Google Co-op

May 31, 12:21:32 PDT> *enochchoi*: I own no pharmaceutical stock

May 31, 12:21:32 PDT> *enochchoi*: or any other healthcare oriented stock

May 31, 12:21:37 PDT> *vkm*: that's really interesting. i just started a
del.icio.us account yesterday after a discussion about tagging. is the
google coop thing similar to that?

May 31, 12:21:56 PDT> *enochchoi*: very differenc, vkm

May 31, 12:21:56 PDT> *CatSilvestre*: is the info you give tailored to
their situation/age/ etc? if so, how do you customize?

May 31, 12:22:27 PDT> *John*: i heard rumors of Google Health... is it
still a rumor or is that Google Co-op - health?

May 31, 12:22:27 PDT> *enochchoi*: vkm: del.icio.us has not integrated
search well

May 31, 12:22:57 PDT> *enochchoi*: vkm: google co-op is all about the
tagging causing categories of tags that are limited in #, and oriented
to health searches

May 31, 12:23:26 PDT> *enochchoi*: John: can't comment on Google Health

May 31, 12:23:43 PDT> *enochchoi*: John: but Google Co-op Health topic
came out on the day that Google Health was rumored to be realeased

May 31, 12:24:05 PDT> *John*: i see

May 31, 12:24:06 PDT> *enochchoi*: vkm: del.icio.us is unstructured, tag
whatever words you like

May 31, 12:24:27 PDT> *enochchoi*: vkm: google co-op has specific tags
that i'm encouraged to only use

May 31, 12:24:52 PDT> *enochchoi*: vkm: which categorizes urls into
meaningful labels, that help sort out a health search

May 31, 12:25:04 PDT> *John*: i see only 6 topics there, so i guess they
are trying to control the quality of content there

May 31, 12:25:17 PDT> *gabber493*: what is this all about?

May 31, 12:25:18 PDT> *vkm*: that sounds more helpful. but what if there
are other types of tags that may apply? are there ways to expand the
list of available tags?

May 31, 12:25:24 PDT> *enochchoi*: vkm: del.icio.us users often tag the
subject of the url; coop tries to tag a category

May 31, 12:25:35 PDT> *enochchoi*: vkm: no

May 31, 12:25:46 PDT> *enochchoi*: vkm: because it affects your search
results

May 31, 12:26:15 PDT> *enochchoi*: Cat: sorry you've left. hope I can
chat with you about patient education another time

May 31, 12:28:06 PDT> *CatSilvestre*: can you tell me a little more
about healthline and heathwise?

May 31, 12:30:02 PDT> *enochchoi*: Cat: glad you're still here!
healthwise is a provider of patient education (the popular healtwise
handbook) ; Healthline is a new search engine, which categorizes results
like google coop but into more categoires

May 31, 12:30:16 PDT> *enochchoi*: Kosmix and Healia are similar offerings

May 31, 12:31:02 PDT> *enochchoi*: The reason I like Healthwise is that
it's very clear about symptoms appropriate for home treatment, and what
needs to come in to see your physician

May 31, 12:31:34 PDT> *enochchoi*: It has less topics than the search
engines but what they have is well structured and readable

May 31, 12:31:43 PDT> *enochchoi*: and clearly actionable

May 31, 12:32:05 PDT> *enochchoi*: Whereas on search engines, you can
get lost with the results

May 31, 12:32:28 PDT> *enochchoi*: Which is why so many efforts are
going into categorizing the results

May 31, 12:33:32 PDT> *CatSilvestre*: sorry, i didn't realize i wasn't
online

May 31, 12:34:07 PDT> *enochchoi*: Cat, vkm, John: i'm excited about
categorization of search results not only for patients searching

May 31, 12:34:07 PDT> *enochchoi*: but also subscribing to feeds of
particular search terms

May 31, 12:34:30 PDT> *enochchoi*: for a physician to see what are the
hot topics in the area of their specialty

May 31, 12:34:36 PDT> *enochchoi*: by following the rss feed of that
category

May 31, 12:35:00 PDT> *enochchoi*: patients have the same opportunity

May 31, 12:35:48 PDT> *enochchoi*: Patients also have the opportunity to
be heard

May 31, 12:36:13 PDT> *enochchoi*: Blogging their experience is often a
safer environment to air their issues

May 31, 12:36:23 PDT> *enochchoi*: especially if they blog anonymously

May 31, 12:36:43 PDT> *enochchoi*: and lets the medical provider know
their concerns, without direct confrontation

May 31, 12:37:02 PDT> *enochchoi*: for groups like mine who are getting
google alerts to mentions of our clinic's name

May 31, 12:37:27 PDT> *CatSilvestre*: PLoS publishes Patient Summaries
of relevant research - basically plain language interpretations. How can
we better disseminate these through health providers?

May 31, 12:38:32 PDT> *enochchoi*: It will be difficult to get providers
to trust patient's summaries

May 31, 12:38:46 PDT> *CatSilvestre*: can you please explain?

May 31, 12:39:04 PDT> *enochchoi*: I think those summaries will have to
increase in authority via the usual #linking-to PageRank mechanisms

May 31, 12:39:25 PDT> *enochchoi*: since patients are largely turning to
search to get information

May 31, 12:39:58 PDT> *enochchoi*: So if you can get a community linking
to good patient summaries, it will be earlier in search results

May 31, 12:40:44 PDT> *enochchoi*: One option is to have participants in
your PLoS Patient Summaries vote, a la Digg. There's a health version of
Digg out there - Dissect Medicine

May 31, 12:41:09 PDT> *gabber759*: do you think pateints should describe
their medical problems annonymously in forums and blogs?

May 31, 12:41:33 PDT> *enochchoi*: No, I can't say that I recommend that.

May 31, 12:41:41 PDT> *enochchoi*: Anonymity is not guaranteed

May 31, 12:41:52 PDT> *enochchoi*: some diagnoses carry heavy stigma

May 31, 12:42:03 PDT> *enochchoi*: and economic peril, in terms of
losing health insurance

May 31, 12:42:24 PDT> *enochchoi*: But for those who can be honest and
open, i think there's a lot of support for them out there.

May 31, 12:42:46 PDT> *enochchoi*: They just have to speak up and
there'll be a torrent of commenters, since so few blog about their health.

May 31, 12:43:06 PDT> *enochchoi*: I think that's why there's more
participation behind members-only forums

May 31, 12:43:36 PDT> *enochchoi*: Participants feel like their privacy
is more guarded and they're talking to others with their condition, who
can understnad

May 31, 12:44:14 PDT> *enochchoi*: But unfortunately, this kind of
participation is not indexed by search, and isn't available to searchers

May 31, 12:45:11 PDT> *enochchoi*: I would caution participants though:
there are very rare incidents of forum members faking their illness to
get sympathy

May 31, 12:45:33 PDT> *enochchoi*: On the web, noone knows who you
really are.

May 31, 12:46:10 PDT> *gabber35*: who is the moderator here right now?

May 31, 12:46:19 PDT> *enochchoi*: i think alex...

May 31, 12:46:32 PDT> *gabber35*: Alex, you there?

May 31, 12:46:36 PDT> *enochchoi*: but i'm here to answer questions! ;)

May 31, 12:46:45 PDT> *MJanofsky*: thanks...

May 31, 12:47:23 PDT> *MJanofsky*: alex????

May 31, 12:47:26 PDT> *enochchoi*: One topic we haven't covered that I
wanted to ask you all:

May 31, 12:47:40 PDT> *enochchoi*: how comfortable would you be using
your phone to sms your doc

May 31, 12:47:52 PDT> *CatSilvestre*: the resources you have recommeded
are great. Can you reccommend others?

May 31, 12:48:13 PDT> *jimjanm*: New question: The Nat'l Library of
Medicine offers a useful "Guide to Healthy Web Surfing"
(http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html); are there
other such guidelines you'd recommend for people to evaluate the
authority of info?

May 31, 12:48:21 PDT> *kevin*: i would have no problem sms my doctor

May 31, 12:48:34 PDT> *enochchoi*: Cat: many others, I'll chat with you
offline... jimjanm's link is great.

May 31, 12:48:53 PDT> *enochchoi*: kevin: so you feel it's secure? it
doesn't fit under HIPAA

May 31, 12:49:14 PDT> *enochchoi*: But I think it's the more immediate
and convenient

May 31, 12:49:20 PDT> *kevin*: My meant for non-confeidential
communications

May 31, 12:49:35 PDT> *enochchoi*: absolutely, then

May 31, 12:49:40 PDT> *kevin*: sorry - bad typing - I meant
non-confidential communications

May 31, 12:50:06 PDT> *enochchoi*: but most of what's really impt and
that you want an immediate answer for is confidental details of your care

May 31, 12:50:11 PDT> *kevin*: I've arrived late - is it possible to get
a transcript of this session

May 31, 12:50:48 PDT> *enochchoi*: the reason i ask is that i use my OQO
to interact online with patients via our personal health record, but
they have to use a browser, not optimized for cell phones

May 31, 12:50:58 PDT> *enochchoi*: kevin: a transcript will be posted

May 31, 12:51:12 PDT> *kevin*: true - but I would assume that many
confidential aspects could be removed

May 31, 12:51:34 PDT> *kevin*: The cell phone display is so small that
detailed information could not be given

May 31, 12:51:41 PDT> *enochchoi*: then the communication would lack the
direction that you're seeking from the doc

May 31, 12:51:52 PDT> *MJanofsky*: Alex-you here?

May 31, 12:52:11 PDT> *enochchoi*: MJanofsky: looks like we're unmoderated

May 31, 12:52:17 PDT> *enochchoi*: would you like to ask a question?

May 31, 12:52:20 PDT> *kevin*: I was thinking more of the cell phoen to
either initiate initial communication, arrange a time to meet up or
follow-up on progress

May 31, 12:52:26 PDT> *CatSilvestre*: is sms being employed to remind
patients of appointments or even to take their medicine?

May 31, 12:52:56 PDT> *enochchoi*: Cat: extensively in asia... my wife's
from singapore and they do so there. in no europe as well

May 31, 12:53:08 PDT> *enochchoi*: kevin: that makes sense

May 31, 12:53:20 PDT> *MJanofsky*: nope-i just need to find out whether
i am suppsosed to be here or the hallway for the 1:00 hour (there were
changes made). Thanks for the great info so far enochchoi

May 31, 12:53:23 PDT> *enochchoi*: the way you can sms google calendar
to make an appoitment or check on them

May 31, 12:53:29 PDT> *kevin*: enoch - are you a real early adoptor in
the medical sector or are there many like you in Palo Alto?

May 31, 12:53:30 PDT> *CatSilvestre*: but not here in the states? why do
you think it hasn't been widely adopted here?

May 31, 12:54:01 PDT> *enochchoi*: kevin: early adopter

May 31, 12:54:19 PDT> *enochchoi*: cat: can't be bothered, patients
aren't demanding it

May 31, 12:54:30 PDT> *enochchoi*: cat: who pays for it?

May 31, 12:54:54 PDT> *enochchoi*: cat: the technology integration into
our existing practice management software e.g. we use IDX

May 31, 12:55:04 PDT> *kevin*: Are the big HMOs driving the use of
internet technology / self service etc. to save costs?

May 31, 12:55:26 PDT> *CatSilvestre*: what about comfort level? (w/
technology) is that a factor and how do you address with patients?

May 31, 12:55:28 PDT> *enochchoi*: kevin: look to asia to see the future
of interacting with your healthcare providers, and other service sectors

May 31, 12:55:33 PDT> *MJanofsky*: Well, it looks like this hour is
coming to a close! If anyone has final questions for Enoch Choi, please
ask them now. :)

May 31, 12:55:51 PDT> *kevin*: thanks - any particular country I should
look at - Korea?

May 31, 12:55:58 PDT> *enochchoi*: kevin: HMOs like kaiser do want to
make use of these technologies, e.g. EPIC

May 31, 12:56:13 PDT> *enochchoi*: Cat: many are comfortable, but MDs
are unwilling to pay

May 31, 12:56:23 PDT> *enochchoi*: and change their practice

May 31, 12:56:38 PDT> *enochchoi*: kevin: korea, japan, taiwan,
singapore, malaysia

May 31, 12:56:48 PDT> *enochchoi*: much more service oriented

May 31, 12:56:56 PDT> *enochchoi*: less privacy concerns

May 31, 12:57:12 PDT> *kevin*: thanks

May 31, 12:57:21 PDT> *enochchoi*: I'm at enochchoimd-thoughts @ yahoo
DOT com for more discussion

May 31, 12:57:32 PDT> *Alex*: Enoch, thanks so much for doing this!

May 31, 12:57:38 PDT> *enochchoi*: You're welcome!

May 31, 12:57:39 PDT> *MJanofsky*: Alex!!!!

May 31, 12:57:43 PDT> *CatSilvestre*: Yes, thank you. Will send you an
email.

May 31, 12:57:46 PDT> *enochchoi*: Quite dizzying, but fun.

May 31, 12:58:35 PDT> *enochchoi*: My bio is here:
http://www.socialtext.net/speakers/index.cgi?enoch_choi

May 31, 12:58:45 PDT> *MJanofsky*: Just a reminder to everyone to visit
the Next Actions page.........http://www.netsquared.org/next-actions