Physician wikis: Do-it-yourself textbooks

Four cardiology fellows at the Cleveland Clinic recently launched a Web site on a platform they believe could be the medical textbook of the future -- the wiki.

A wiki, which means "fast" in Hawaiian, is an open-source Web site, built on the wisdom-of-crowds theory. Anyone can add, remove, edit or change content to make it better.

At least 30 medical wikis have popped up, with topics ranging from radiology to billing to rosacea. Most have few contributors, but all have similar goals -- to create a more vibrant, up-to-date conversation and library of knowledge than can be found in a textbook or journal.

"Our goal is to really develop a comprehensive body of knowledge that is up-to-date and accurate and very accessible," said Brian Jefferson, MD, an AskDrWiki co-founder.

link, modeled after the popular online encyclopedia Wikipedia, was created as a place where a group of cardiologists could share and exchange information in a wiki format that could be accessed from anywhere.

But among those familiar with wikis and what can go wrong when literally anyone can modify information, there are concerns about doctors using them for critical information.

As more medical wikis launch, experts say the creators will need to break away from the traditional wiki model to ensure that the information accessed is accurate. That is what many medical wikis are doing, which makes adding content slower but allows time for fact-checking.

"If DrWiki evolves (and I hope it will) into a large, searchable repository of frequently updated, high-quality medical information with a track record of accuracy and strict adherence to good editorial policies, I think medical libraries will embrace it and add it to the repertoire of tools they currently utilize," said David Rothman, an information services specialist at the Community General Hospital Medical Library in Syracuse, N.Y., in an e-mail interview.

New type of wiki

Rothman runs an independent blog, davidrothman.net, where he tracks what's going on in the world of medical wikis. He has guided and consulted new medical wikis in an effort to make them more reliable.

As AskDrWiki gained popularity, several changes were made after consulting with Rothman and other bloggers. One of the most important changes, said Rothman and other wiki watchers, was the requirement that all contributors be credentialed medical professionals.

Under the traditional wiki model, anyone can make changes to content and can do it anonymously.

"Because we initially started [AskDrWiki] as a group of fellows, it didn't require credentialing, since I knew everyone contributing information," said Kenneth Civello, MD, MPH, who co-created it along with Dr. Jefferson, Shane Bailey, MD, and Mike McWilliams, MD. "Then it became bigger than anyone expected."

After a story about the site ran in a British medical journal in December 2006, site traffic increased significantly. Then, within two weeks after a local newspaper story ran, there were 5,000 new visitors to the site, many from outside the U.S., and the number of contributors grew from 30 to about 100. Then AskDrWiki started a credentialing process for contributors.

So far, only about 35 of the new users are credentialed, Dr. Civello said. About 30 of the new contributors are from other specialties, so the team decided to expand the wiki's content beyond cardiology.

Not all medical wikis are physician-run. For example, Stewart Brower, assistant librarian at the University at Buffalo Health Sciences Library, launched PubDrug, a pharmaceutical wiki. Brower started it after becoming increasingly frustrated with the subscription-based information services at the library. The university's school of pharmacy became involved with the project, and now fourth-year pharmacy students contribute to the wiki as part of the curriculum.

Brower said PubDrug differs from the wiki formula in that articles are posted only by pre-approved contributors, and they are locked down from outside revision once they appear. Similarly, AskDrWiki now locks down any content describing prescription dosages.

Even though medical wikis will need to break away from the traditional wiki model to be reliable, Medical Library Assn. board member T. Scott Plutchak, director of the Lister Hill Library of the Health Sciences at the University of Alabama at Birmingham, said the original goal of creating a way for many people to work together on a common project is one that could prove to be very beneficial to the medical community.

Libraries of the future

Rothman believes that with careful, calculated growth, medical wikis can be just as reliable as other mainstream sources.

"A medical wiki with good editorial policies and vetted contributors may soon contain information of quality similar to an established medical journal or textbook," Rothman said.

Drs. Civello and Jefferson think wikis eventually will become favored over textbooks, but Brower believes there will always be a need for both.

Textbook publishers already are going digital with online versions, but wikis present the opportunity for more contributors, said Plutchak, who also believes wikis will be an adjunct to the traditional textbook.

The AskDrWiki founders also are confident that their model of the medical wiki will catch on. "When you talk to people about it, they light up and realize it's something good," Dr. Jefferson said.