In the beginning … a brief history of the internet

Although the internet as we know it is relatively young, having existed in its current form since about 1995, the concept of a connected network of information and linked ideas has been around for at least 60 years (Bush, 1945). Physicians were highlighted, in particular, as a group who would find the ‘memex’ extremely useful. During the 1960s to the 1980s, what we now know as the world wide web continued to develop, incorporating e-mail and early webcams and, more recently, the participatory software and virtual environments that form the backbone of what can be termed ‘Web 2.0’.

In 1990, Tim Berners-Lee and CERN implemented a hypertext system with the aim of providing efficient and timely information to the research community. Two implicit aims of the internet, linking community and improving the availability of information, were apparent in the system's creation.

Since it first took form in the early 1960s, the internet has evolved at an exponential rate. In 1994 there were just over 20 million users worldwide; by 2009 there were over 1.5 billion (World Bank, 2010). In the mid 1990s, what we now know as the world wide web first took form, and it has since become the information tool of choice for many. In the process, the internet has changed society and the ways in which we interact beyond all recognition (Naughton, 2006).

The mid 1990s were a clear turning point. What had been a specialized, text-based information environment became transformed into a more accessible and interactive platform. The first sale on Echo Bay's Auction Bay, precursor of eBay, occurred in 1994 (Collins, 2010). Crucially, 1996 saw the first web-based free e-mail service, Hotmail (Sharma, 2009), changing the way in which we communicate for ever. In 1994, graphical web browsers as a whole, which make the internet as we now know it so accessible and interactive, were still in their infancy: the current search engine favourite, Google, was still four years away (Boulton, 2009). Now that we live in a world of potential constant connectivity and mobile multimedia ‘on demand’, the early years of the internet seem charmingly primitive.

Since the internet first became widely available in the mid 1990s, it has established itself as the major source of information worldwide in many areas, including on some aspects of healthcare.

What has come to be occasionally termed, at least retrospectively, as Web 1.0 was the first incarnation of the internet. It was mainly text-based and very didactic, and subject experts were the only ones who made information available. A high level of technical skills was required to compose web pages, and access to the internet was only available from a limited number of wired connections and often very expensive.

The world in which we live now is very different. Anyone with a mobile device and a mobile internet connection can access the world wide web at any time. Content is more flexible and personalized, and no special skills are required to create a very effective wiki or blog, beyond a basic ability with ICT applications such as word processing.

Since it was first coined at the end of the 1990s, the term Web 2.0 has come, in certain circles, to provide a convenient umbrella term for a much more interactive and collaborative evolution of the internet.

In healthcare, Web 2.0 applications are just beginning to come into their own as a potential way to improve and maintain education and healthcare information in a wide range of situations, for caregivers and consumers alike. This book concentrates on the provision of healthcare to humans, and the theme of supporting clinical practice underpins many of the contributions.

The book is not intended as a manual, but rather as a snapshot overview of how some health organizations and professionals are using what are sometimes currently termed Web 2.0 applications and methods of working.

After an introductory overview to Web 2.0 and healthcare information, Part 2 of the book looks at some of the longer-range implications for the development of healthcare information. The investigations here incorporate case studies to illustrate the effective use and implementation of Web 2.0 applications. These range from wikis and blogs to RSS feeds and Twitter.

Part 3 includes case studies from a very practical point of view in a range of environments, and Part 4 aims to look into the future, where the Semantic Web, or Web 3.0, is already apparent as the next development of the internet.

What is health information?

Healthcare and medical information professionals have always been quick to adopt new technology (Kumar and Rawat, 2010; McKnight, 2005). This is, in part, due to the nature of their users: healthcare professionals require their information to be as up to date and accurate as possible. The consequences of not having such information to hand are laid out starkly by HIFA2015:

Lack of access to information remains a major barrier to knowledge-based healthcare in developing countries. The development of reliable, relevant, usable information can be represented as a system that requires co-operation among a wide range of professionals, including healthcare providers, policy makers, researchers, publishers, information professionals, indexers and systematic reviewers (Godlee et al., 2004).

Before we look in more detail at the potential for Web 2.0 to influence healthcare and medical information, it is pertinent to establish just what is meant by health information.

Broadly, health information consumers divide into two groups: those who deliver care, and those who receive it. Healthcare deliverers divide into two further broad groups: those who have direct contact with patients and those who make a difference to patient care indirectly. Medics, nurses and patient information professionals fall into the first group; librarians, managers, information professionals (including researchers) and health informatics professionals fall into the second group, in the majority of cases.

The direct deliverers subdivide into many further groups: qualified physicians and nurses, medical and nursing students, and allied health professionals are just some. Each group requires a different type of information: the qualified medics and nurses may require information to enable them to treat a patient, to enhance their own continuing professional development or to prepare a presentation, ward meeting, training session or board paper. Students, on the other hand, may simply require a brief overview of a condition or intervention in order to pass an assignment and build a foundation for their further career development.

The internet and the web have effected a profound and permanent change in our world and the way we view it. In both our professional and our social lives the consequences are with us every day as we try to evaluate, assimilate and utilize each new stage in the technological evolutionary process. Web 2.0 is the name used for convenience as a label for the present stage, in which the emphasis is increasingly on interactive communication and semantic enrichment. (Exactly what is meant by ‘Web 2.0’, and indeed whether such a concept as ‘Web 2.0’ really exists, is discussed in more detail in Chapter 2 ‘Web 2.0 in Healthcare Information: an overview’.) Web 2.0 applications are just beginning to reveal their potential as a way of improving and maintaining education and healthcare information in a wide range of situations, for caregivers and consumers alike.

Such is the pace of change, and such is the range of Web 2.0 tools and services on offer, that, while the journal literature provides an extensive coverage of recent developments, any attempt to produce a book surveying and summarizing the current state of affairs is inevitably destined to be overtaken by events. That certainty should not be seen as an argument against trying, though: the author or editor who waits for a more settled and stable state of affairs will in all probability be doomed to wait for ever. We share the belief of those others who have ventured into print in this area that there is a strong argument for providing the more considered, in-depth and reflective overview of web-based activities that a book makes possible; mapping key stages in the web's evolution, in the impact it has on our lives, and in the opportunities it enables us to grasp. Each book on the web is thus part of an incremental process of both advocacy and record. So, in formulating the case for this book we were – and remain – convinced that there is indeed a place for it and an audience that will benefit from reading it.

Let us first be clear as to what this book is not. It is not a manual designed to provide definitive and exhaustive instructions in how to develop or use Web 2.0 tools. The message throughout is suggestive rather than prescriptive.

Introduction

The ultimate aims of healthcare information are to provide information, whether mediated or directly, and to allow patients or health consumers to maintain a good level of health, manage an existing condition or prevent conditions worsening.

Under the NHS Constitution, information provision is now a legal right for patients in the UK. Patients have the right to ‘be given information about [the] proposed treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing’. In addition, patients have the right ‘to be involved in discussions and decisions about your healthcare, and to be given information to enable…this’ (Department of Health, 2010).

Web 2.0 would seem to represent a perfect platform for providing patient or consumer information and support for public health in general, offering new, innovative, cost-effective, responsive and timely ways in which to provide that information.

What sources do patients use for information?

In the UK, patients attending their GP surgery (family practitioner) or being discharged from hospital will often be given an information leaflet about their condition which may or may not include details of websites. There are some excellent websites, such as www.patient.co.uk. Many charities also provide a wide range of well researched information, often available for free download from their websites. When medicines are purchased, whether on prescription or over the counter, information leaflets are provided in the packaging.

Some dissatisfaction has been expressed by patients regarding the information they receive from medical and healthcare professionals, nonetheless (Kinnersley et al., 2008). Further, studies suggest that although many patients use health websites that have been put together by government-backed organizations, such as NHS Direct and the BBC, these sites do not necessarily meet their needs (Huntington et al., 2007). In future, however, the way in which patients and health consumers receive their health information may well be through a computer-mediated avatar (Van den Brekel, 2007).

What is of consequence to us as potential mediators of information, then, is the reason why patients would turn to the Web 2.0 realm for health information. Change appears to be taking place in many areas: on the one hand, there is distrust of authority and experts; on the other, an information explosion has been made possible by modern information and communication technologies (Lor and General, 2008).

Like the printing press, telephone and television before it, the internet has changed forever the way we disseminate and retrieve information.

Both as a group and as individuals, information professionals are rich in imagination, resourcefulness and the ability to innovate, as well as the ability to adopt and adapt to new technology. All of these skills are very apparent from the many and varied examples in this book of how Web 2.0 applications are being used in healthcare information settings.

The sheer variety of the projects outlined here is also testament to the flexibility of Web 2.0 applications, with each service highlighting different features, depending on the needs of their users. Whether it is a practical application to provide information in a more timely and cost-effective manner to users and non-users alike, or a more academic approach, there is a Web 2.0 application that can be used. Some common themes have, however, emerged.

The first of these is the use of the web as a platform. Users are no longer limited to having to use applications on their desktop, laptop or netbook. Online file storage options such as Flickr and Google Docs also mean that users no longer need to rely on memory sticks or external storage. Applications such as haptics and virtual environments such as Second Life offer tremendous potential for the future in all kinds of environments, particularly health.

A second major theme is the trend towards collaborative working. Web applications such as Google Docs, wikis and blogs provide the opportunity for individuals and teams to work on documents and information no matter where they are located. If we assume that, in general, crowds have a higher level of wisdom and knowledge than individuals, then there is also the facility for members of those teams to correct erroneous information. Both information professionals and healthcare professionals are experienced in working collaboratively in multidisciplinary teams to achieve a result: it is now possible to replicate those methods of working in an electronic environment.

A third theme is the use of mobile technology, paving the way for ‘web anywhere’.