Crowdsourcing moving beyond hospital lounges and into social media

Long before the rise of the Internet and the term "crowdsourcing" was used, physicians often turned to one another to solve tough clinical cases or find answers to questions they exhausted every other avenue trying to solve.

The word crowdsourcing was first coined by author Jeff Howe and his editor Mark Robinson in a 2006 Wired magazine article, and it means outsourcing tasks to a large, undefined group through an open call. The way physicians crowdsource is evolving, as their communities of peers expand beyond the privacy of hospital lounges and physician-only websites and into mainstream social media channels such as Twitter.

"The words 'I don't know' are three very powerful words," said Howard Luks, MD, an associate professor for orthopedic surgery at New York Medical College in Valhalla, N.Y. Dr. Luks said the more physicians are able to admit what they don't know and seek the help of others, the better it will be for themselves and patients.

Many doctors-only online communities have been around for some time, but many physicians, like Dr. Luks, have found that even when some online sites boast user rates in the 100,000 range, it's usually a handful of doctors who are active. Using channels such as open social networking sites can help expand the pool of experts with whom you can crowdsource.

Experts say the key to successful crowdsourcing in health care is to ask questions or answer them in a way that gets to the point and does not violate patient privacy. Experts say physicians should:

• Be specific to the topic or situation, but not the patient. "There are ways to mask the identity but still divulge all of the clinical information," Dr. Luks said.
• Be transparent about what you don't know, said Howard Krein, MD, an otolaryngologist and plastic surgeon in Philadelphia. He is also chief medical officer of OrganizedWisdom, a New York City-based online repository of health information culled from many sources. Dr. Krein said some physicians not only answer questions they may not be qualified to answer but also are afraid to ask a question, because they don't want others to discover they don't know something. The expanding online community is a valuable resource when you've hit a dead end.
• Use all available resources. Experts say the value of crowdsourcing is gaining ideas that deserve further research, not finding the one and only answer. Taking an idea and using other online channels to explore it can be a valuable step to finding the right outcome.
• Share what you have learned. Spreading the knowledge you have gained within your various social networking channels will add to the knowledge base of others.

Some physicians may think using open sites would expose them to more liabilities, but experts say if they are following requirements of the Health Insurance Portability and Accountability Act, that won't be the case. In fact, what a physician says in a closed community should not be much different from what is said in an open community. Patient identifiers listed under HIPAA shouldn't be disclosed in any forum, experts say.

Robert Belfort, an attorney with Manatt, Phelps & Phillips in New York City, said that even though specifics might not be used, a physician's comments could contain enough information for a person to be identified. Physicians must use excellent judgment when deciding how much information to share.

He said he would advise a physician to be even less specific about patient identifiers when it comes to crowdsourcing on an open site. But in both closed and open forums, the physician needs to consider the combination of their location -- particularly if they are in a small community -- and the uniqueness of the facts being presented.

The websites a physician uses to crowdsource could change the quantity and the quality of the responses. Where a physician decides to help others who are crowdsourcing could impact his or her own reputation and ability to share knowledge with a wider audience.

Ijad Madisch, co-founder and CEO of ResearchGATE, a scientific network for researchers based in Berlin, said popular social media forums are useful for crowdsourcing when there is a connection with the people you are consulting. But because they are open networks, he said the "two-cents" rule often comes into play.

"This is when people without the credentials or experience provide a response to your question," Madisch said. "The vast majority of these answers either have no factual basis, are completely off topic, or are merely self-serving attempts to steer the conversation."

That has not been Dr. Luks' experience, however. He said he makes connections with people he believes are valuable sources, and if they respond to something, they generally have something useful to share. On one occasion, he asked the opinion of a dermatologist he met on Twitter about a rash a relative was experiencing. On Twitter you can tag someone in a post, so it's directed to that person but viewable by everyone. He got the appropriate response from the physician he tagged, but the handful of other responses he received also were useful.